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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 : 3.2.3 Bone-Anchored Hearing Aid (BAHA) : 3.2.3.1 Prior Authorization

3.2.3.1
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 may be granted for clients who are 5 years of age and older with all of the following:
Documentation of a multidisciplinary assessment including physical, cognitive, communicative, and behavioral limitations describing the client’s auditory disability and expected benefit with use of the BAHA implant
Benefit-eligible conditions may include, but are not limited to the following:
Refer to:
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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