TMPPM 2007 >23.3.2.5 Second Revisit

The second revisit procedure code 99212, includes aided sound field testing performed by a contracted evaluator 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 on Form 3503, Hearing Aid Evaluation Report. The second revisit is available as needed after the post-fitting check and the first revisit.

The following table lists hearing aid instrument, assessment, and revisit procedure codes.

Note: Hearing aid procedures indicated with "MR" must be submitted with the 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.


Procedure Code	Medicaid Fee
R-99211	*
R-99212	*
R-V5010	$44.35
R-V5011	$50.00
R-V5030	MR
R-V5040	MR
R-V5050	MR
R-V5060	MR
R-V5070	MR
R-V5080	MR
R-V5090	$100.00
R-V5100	MR
R-V5110	$150.00
R-V5120	MR
R-V5130	MR
R-V5140	MR
R-V5150	MR
R-V5160	$170.00
R-V5170	MR
R-V5180	MR
R-V5190	MR
R-V5200	$170.00
R-V5210	MR
R-V5220	MR
R-V5230	MR
R-V5240	$170.00
R-V5241	$115.00
R-V5242	MR
R-V5243	MR
R-V5244	MR
R-V5245	MR
R-V5246	MR
R-V5247	MR
R-V5248	MR
R-V5249	MR
R-V5250	MR
R-V5251	MR
R-V5252	MR
R-V5253	MR
R-V5254	MR
R-V5255	MR
R-V5256	MR
R-V5257	MR
R-V5258	MR
R-V5259	MR
R-V5260	MR
R-V5261	MR
R-V5262	MR
R-V5263	MR
R-V5264	$18.90
R-V5265	$18.90
R-V5275	$18.90
R-V5298	MR
R-V5299	MR
* Refer to the Physician Fee Schedule on the TMHP website at www.tmhp.com