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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 : 3.2.2 Auditory Brainstem Implant (ABI) : 3.2.2.1 Prior Authorization

3.2.2.1
The following implantable hearing devices and services require prior authorization:
Requests for prior authorization must be submitted to the SMPA Department with documentation supporting the medical necessity for the requested device, service, or supply.
Prior authorization requests and claims for ABI is limited to clients with a condition of neurofibromatosis, type II or schwannomatosis.
Refer to:
Subsection 2.2.1, “Limitations and Required Forms” in this handbook for additional information about replacement batteries.
Subsection 3.2.4, “Sound Processor Replacement and Repair” in this handbook for more information about sound processor repair or replacement.

Texas Medicaid & Healthcare Partnership
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