TMPPM 2008 > Texas Medicaid Services > Hearing Aid and Audiometric Evaluations > Reimbursement

23.2 Reimbursement

Hearing aids and audiometric services are reimbursed in accordance with 1 TAC §355.8141. Hearing evaluations and the first and second revisits are reimbursed according to the maximum allowable fee. Procedure codes R-99211 and R-99212 should be billed for the first and second revisits, respectively.

Reimbursement for ear molds and the fitting and dispensing fee is limited to the established maximum fee.

Hearing aid procedures indicated with "MR" (Manually Review) must be submitted with the Manufacturer's Suggested Retail Price (MSRP) in the Comments field of the claim. If the MSRP is not included in the comments field on the original submission, the claim will be denied. Providers will be required to submit their request as an appeal, and must include an invoice validating the cost of the instrument. The maximum allowable fee for the hearing aid instrument includes:

•Acquisition cost of the hearing aid (the actual cost or net cost of the hearing aid after any discounts have been deducted).

•Manufacturer's postage and handling charges.

•All necessary tubing, cords, and connectors.

•Bone conduction headbands.

•Telephone coils.

•Compression circuits.

•Contralateral Routing of Offside Signal (CROS)/Bilateral Contralateral Routing of Offside Signal (BICROS) features.

•Instructions for care and use.

•One-month supply of batteries.

Charges for hearing aid components must be verified by the manufacturer's invoice and price lists. The fitting and dispensing fee includes the postfitting check of the hearing aid within five weeks after the dispensing date.

Note: Charges to the client for covered services constitute a breach of the Medicaid contract.

Refer to: "Reimbursement Methodology" for more information on reimbursement.

"Billing Clients" for more information.

Fee schedules for services in this chapter are available on the TMHP website at www.tmhp.com/file library/file library/fee schedules.