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December 2016 Texas Medicaid Provider Procedures Manual

Vision and HearingServices Handbook : 2 Nonimplantable Hearing Aid Devices and Related Services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.2 Hearing Screenings : 2.2.2.1 Routine Hearing Screenings

2.2.2.1
Routine hearing screenings that are required as part of the newborn hospital stay and as part of a THSteps medical checkup are included in the Texas Medicaid hearing services benefit. These routine screenings are not reimbursed to audiologists, hearing aid fitters and dispensers, or physicians.
Newborn Hearing Screen
The newborn hearing screening is included in the reimbursement to the hospital for the newborn hospital stay and is not reimbursed separately. A newborn hearing screening must be offered to each newborn by the facility where the birth occurs, through a program mandated by the Texas State Legislature and certified by the Texas Department of State Health Services (DSHS). The screening is covered as part of the newborn delivery. An infant born outside a birthing facility and not admitted to a birthing facility shall be referred to a facility that provides newborn hearing screening. If a facility is not required by legislative mandate to perform newborn hearing screening, a referral must be made to a facility that offers the screening.
Refer to:
Subsection 5.3.9, “Newborn Examination” in Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information about the newborn hearing screening.
THSteps Medical Checkup Hearing Screen
Hearing screening is a required component of the THSteps medical checkup, and a standardized audiometric hearing screening is required at specific ages according to the periodicity schedule.
Refer to:
The THSteps Medical Checkups Periodicity Schedule including the footnotes, which is available on the DSHS website at www.dshs.state.tx.us/thsteps/providers.shtm, for coverage criteria when performed as part of a THSteps medical checkup.
Subsection 5.3.11.2.3, “Hearing Screening” in Children’s Services Handbook (Vol. 2, Provider Handbooks) for more information on THSteps checkup hearing screening.

Texas Medicaid & Healthcare Partnership
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