Table of Contents Previous Next

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 : 2.2.5 Hearing Aid Services

2.2.5
The following additional hearing aid related procedures are benefits for services that are rendered to clients of any age:
 
The following additional hearing aid related procedures are benefits for services that are rendered to clients who are 20 years of age and younger only:
 
Texas Medicaid may reimburse hearing aid fitters and dispensers for the following services:
 
Limitation: As often as is medically necessary
Procedure code: 92564 (SISI hearing test)
Limitation: 1 fitting per hearing aid procedure code per 5 rolling year period, regardless of the number of times a device is returned as unacceptable during a 30-day trial period
Limitation: 1 dispensing fee each time a hearing aid is dispensed and a new 30-day trial period begins
Procedure codes: V5090 and V5241 (for clients of any age) and V5110, V5160, V5200, and V5240 (for clients who are 20 years of age and younger)
Limitation: 2 per calendar year when billed by any provider
Procedure codes: 92592 (first and second revisits for monaural fittings for clients of any age) and 92593 (first and second revisits for binaural fittings for clients who are 20 years of age and younger)
Note: Services for Texas Medicaid clients who are 21 years of age and older and who received 2 hearing aid devices (binaural) on or before October 1, 2012, may be reimbursed to the client’s treating physician or audiologist using procedure codes 99211 and 99212.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.