CSHCN Services Program 2010 > Hearing Services > Benefits, Limitations, and Authorization Requirements

19.2.3 Prior Authorization Requirements

The CSHCN Services Program does not require prior authorization for hearing aid devices and services that are medically necessary and that are provided within the limitations outlined in this article unless otherwise indicated.

To submit prior authorization requests for those services that do require prior authorization and for medically necessary services required outside of program benefits, providers may use the CSHCN Services Program Authorization and Prior Authorization Request Form and Instructions form.

Requests for prior authorization must be submitted to the TMHP-CSHCN Services Program Authorization Department and must include documentation that supports the medical necessity of the requested device, service, or supply.

Prior authorization is required only for the following devices and services:

•Additional devices and services that exceed benefit limitations as outlined in this article

Refer to: The specific sections throughout this chapter for information about submitting the prior authorization requests for devices and services beyond benefit limitations.

•Hearing aids that are medically necessary but are not currently benefits of the CSHCN Services Program

•Replacement of hearing aids within 5 years of the initial purchase

•Hearing aid accessories including, but not limited to, chin straps, clips, boots, and headbands

The following table summarizes the documentation requirements for the items that require prior authorization:

Description	Prior Authorization Requirements
Hearing aids that are medically necessary but are not currently benefits of the CSHCN Services Program	The prior authorization request must include: •The medical necessity for the requested hearing aid device. •The name of the manufacturer. •The manufacturer's suggested retail price (MSRP) or average wholesale price (AWP) or the provider's documented invoice cost. •The model number, serial number, and the dates that the warranty is in effect for the requested hearing aid.
Replacement of hearing aids within a 5-year period	Requests for prior authorization must include documentation that supports medical necessity which may include documentation that loss or irreparable damage has occurred.
Hearing aid accessories include, but are not limited to, chin straps, clips, boots, and headbands.	Requests for prior authorization for hearing aid supplies will be considered when submitted with documentation that shows that the requested supply is medically necessary for the proper use or functioning of the hearing aid device.

Authorizations may be submitted online, by fax, or by mail to:

The prior authorization number must be included on the claim form when submitted to TMHP.