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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 : 3.2.4 Sound Processor Replacement and Repair

3.2.4
3.2.4.1
Replacement and repair of a sound processor require prior authorization.
Documentation by the provider must explain the need for the replacement of the sound processor. The processor must be used for a minimum of 12 months before replacement of the unit will be considered.
The prior authorization request must include evidence of the purchase, such as the manufacturer’s warranty.
Repair of a sound processor will be considered for prior authorization with documentation of medical necessity for the requested repair. Repair of a sound processor will be manually priced at the time the prior authorization is reviewed and granted. If the actual cost of the repair differs from the prior authorized fee, the provider must contact the SMPA Department to update the authorization before filing a claim for the repair services.

Texas Medicaid & Healthcare Partnership
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