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December 2016 Texas Medicaid Provider Procedures Manual

Vision and HearingServices Handbook : 3 Implantable Hearing Devices and Related Services : 3.2 Services, Benefits, Limitations and Prior Authorization : 3.2.1 Cochlear Implants : 3.2.1.3 Auditory Rehabilitation

3.2.1.3
Auditory rehabilitation is a benefit of Texas Medicaid when it is medically necessary for clients who have received a surgically implanted hearing device, or who have prelingual or postlingual hearing loss when the treating physician has determined that auditory rehabilitation would be beneficial.
The following procedure codes may be reimbursed for auditory rehabilitation:
 
L92626
One auditory rehabilitation evaluation and 12 visits per six rolling months may be reimbursed without prior authorization. Additional visits during a six rolling month period for clients who are 12 months of age through 20 years of age require prior authorization.
Procedure code 92627 is an add-on procedure, and must be billed with the primary procedure code 92626 to be considered for reimbursement.
Note:
Refer to:
Frequency modulated (FM) systems are not benefits of Texas Medicaid.

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