CSHCN Services Program 2010 >19.2.2.4 Fitting and Dispensing Visits and Revisits

Prior authorization is not required for fitting and dispensing visits and revisits.

Hearing aid visits include the fitting and dispensing visit, the first revisit, and the second revisit (as needed):


Visit	Limitations
Hearing aid examination	Procedure code 92591 may be reimbursed for a hearing screen or other hearing aid examination.
Fitting and dispensing visit	Includes the fitting, dispensing, and post-fitting check of the hearing aid. The post-fitting check of the hearing aid must be performed within 5 weeks of the initial fitting. The post-fitting check is part of the dispensing procedure and will not be reimbursed separately.
First and second* revisit	If additional visits are required after the post fitting check, two additional revisits may be reimbursed as medically necessary. The first revisit must include a hearing aid check. The second revisit must include either a real ear measurement or aided sound field testing according to the guidelines specified for the hearing evaluation. If the aided sound field test scores suggest a decrease in hearing acuity, the provider must include puretone and speech audiometry readings from the first evaluation. The second revisit is available as needed after the post-fitting check and first revisit. Procedure code 92592 may be reimbursed for the first and second revisit for a monaural fitting. Procedure code 92593 may be reimbursed for the first and second revisit for a binaural fitting.

Client acknowledgment statement. To confirm that the client was evaluated and offered an appropriate hearing aid that meets the client's hearing need, the client must sign an acknowledgment statement (created by the provider) before the provider dispenses the hearing aid device and supplies. The statement must be maintained in the client's medical record. Retrospective review may be performed to ensure that the documentation supports the medical necessity of the device, service, or supply.

30-day trial period certification statement. After the hearing aid has been dispensed, the client must be allowed a 30-consecutive-day trial period that begins with the dispensing date to determine satisfaction with a purchased hearing aid. The hearing aid fitter/dispenser must provide the client with a written agreement that includes the beginning and ending dates of the 30-day trial period. The contract agreement must include all charges and fees associated with the trial period as well as the name, address, and telephone number of the State Board of Examiners for Speech-Language Pathology and Audiology. The client must receive a copy of this agreement and a copy must also be maintained in the client's medical record.

During the trial 30-day trial period, if the client is not satisfied with the purchased hearing aid or if hearing is not improved with the use of the purchased hearing aid, the client may return it to the provider. Providers may dispense additional hearing aids as medically necessary until the client is satisfied with the results of a hearing aid or until the provider determines that the client cannot benefit from the dispensing of an additional hearing aid. A new trial period begins with the dispensing date of each hearing aid.

The fitter/dispenser must allow 30 days to elapse from the hearing aid dispensing date before completing a 30-day trial period certification statement, which indicates that the client has completed the trial period and has accepted the dispensed hearing aid. The certification statement must be maintained by the provider in the client's medical record.

The hearing aid provider must use the appropriate fitting and dispensing procedure code for services rendered during the trial period. No additional fees may be charged to the client or to the CSHCN Services Program during this period.