CSHCN Services Program 2010 > Hearing Services > Reimbursement

19.4 Reimbursement

Hearing aids and related services may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid. Additional charges (e.g., rental fees) to the client for covered services constitute a breach of the provider's contract with the CSHCN Services Program.

The medically necessary hearing aid devices that are not currently a benefit of the CSHCN Services Program (procedure code V5298) and the hearing aid accessories not included in the hearing aid package (procedure code V5267) are manually priced and may be reimbursed the lower of the billed amount or the manufacturer's suggested retail price (MSRP) less 18 percent when purchased.

Cochlear implants or ABIs may be reimbursed the lower of the billed amount or the amount allowed by Texas Medicaid.

For fee information, providers can refer to the Online Fee Lookup (OFL) on the TMHP website at www.tmhp.com.