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23.4 Limitations and Exclusions
The following limitations and exclusions apply:
• Reimbursement for a hearing aid instrument is limited to eligible clients, 21 years of age and older, whose air conduction puretone average in the better ear is 45 dB or greater.
•Hearing aid purchases are limited to one every six years with the exception of clients birth through 20 years of age through PACT.
•Clients birth through 20 years of age must be referred to PACT.
•Services for residents in nursing facilities (skilled nursing facility [SNF], intermediate care facility [ICF], or extended care facility [ECF]) must be ordered by the attending physician. The order must be on the client's chart and state the condition necessitating hearing aid services and must be signed by the attending physician.
•No payment is made for replacement of batteries or cords.
•No payment is made for repairs or replacements of lost, destroyed, or inappropriate hearing aids.
•No binaural fittings are available except in certain documented cases of legally blind, hearing-impaired clients who have no other available resources. This information must be documented in the client's file as well as on the claim submitted for payment for hearing aid services.
•U.S.-manufactured hearing aids must be considered when the purchase price and quality are comparable to those of foreign manufacturers.
•Home visit hearing evaluations and fittings are permitted only with the physician's written recommendation.
•Auditory training, speech, reading, or other rehabilitative services are not included.
Refer to: "CMS-1500 Claim Filing Instructions" .
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