CSHCN 2008 > Physician > Benefits and Limitations

24.3.5 Audiometry/Hearing Services

For clients under 21 years of age, the CSHCN Services Program covers hearing aids and related services through the Program for Amplification for Children of Texas (PACT).

For more information about PACT, contact:

PACT
Health Screening Branch
1100 West 49th Street, MC-1918
Austin, TX 78756-3199
1-800-252-8023

Website: www.dshs.state.tx.us/audio/program.shtm

Hearing services provided by the PACT program are authorized through PACT for clients under 21 years of age. The CSHCN Services Program covers audiological testing for clients 21 years of age and older not covered through PACT. Hearing aids for clients 21 years of age and older may be reimbursed at the current PACT reimbursement rates for the prescribed hearing aid.

For clients of any age, the CSHCN Services Program may reimburse physicians and APNs that provide hearing tests to clients whose hearing is found to be suspect on the routine screening, whether or not hearing is found to be impaired. To provide CSHCN Services Program services, each NP or CNS must be licensed as a registered nurse and recognized as an APN by the Texas BON.

CSHCN Services Program clients who are over 16 years of age, legal residents of the State of Texas, and are employable, may be eligible for assistance from the Department of Assistive and Rehabilitative Services (DARS). The CSHCN Services Program may request that clients meeting those requirements apply to DARS, as the CSHCN Services Program is the payer of last resort.

Authorization is not required for hearing services provided by physicians. Comprehensive hearing tests are considered a benefit of the CSHCN Services Program for the following procedure codes: 5/I-92551, 5/I-92552, 5/I-92553, 5/I-92555, 5/I-92556, and 5/I-92557. If three or more of these procedures are performed on the same day, they must be billed as 5/I-92557. Claims for any combination of three or more tests billed separately on the same day as basic audiometry are denied. Providers may not bill any of the above tests on the same day as 5/I-92557.

The following additional tests are also benefits of the CSHCN Services Program:

Note: Procedure codes 5/I-92567 and 5/I-92568 are paid for diagnostic purposes only.

The same provider may not bill procedure code 5/I/T-92587 on the same day as procedure code 5/I/T-92588.

Tympanometry (impedance testing) may be considered for reimbursement as an objective diagnostic test of middle ear disease. Procedure code 5/I-92567 is limited to four services per year by the same provider. Acoustic reflex provides information about the middle ear, specifically middle ear muscle reflexes in response to sound (admittance changes). The test can help distinguish between sensory (cochlear) hearing loss and neural (retro-cochlear hearing loss).

Procedure codes 5/I-92568 and 5/I/T-92569 are benefits when billed with the following diagnosis codes: