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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) : 3.2.3.2 Limitations

3.2.3.2
BAHAs are a benefit for clients who are 5 years of age and older.
Replacement batteries for the BAHA (procedure code V5266) do not require prior authorization. The replacement batteries are limited to clients with a previously paid hearing device. Replacement batteries for clients who did not receive the hearing device through Texas Medicaid will be considered for reimbursement on appeal with a physician’s statement documenting the medical necessity.
Procedure codes L8691, L8692, and L8693 will be denied as part of another service when billed by any provider with the same date of service as procedure code L8690.
Procedure code L8692 for the BAHA device and components may be reimbursed once per day with prior authorization.
Bilateral BAHA procedures are not benefits of Texas Medicaid.

Texas Medicaid & Healthcare Partnership
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