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December 2016 Texas Medicaid Provider Procedures Manual

Vision and HearingServices Handbook : 3 Implantable Hearing Devices and Related Services : 3.4 Claims Filing and Reimbursement : 3.4.2 Reimbursement

3.4.2
Implantable hearing aids and related services are reimbursed in accordance with 1 TAC §355.8141.
Implantable hearing aids and related services are reimbursed at the lesser of the billed charges or the published Texas Medicaid fee. Unless otherwise indicated, providers may not make additional charges to the client for covered services; such charges constitute a breach of the Texas Medicaid contract.
Requested items that are not represented by a specific procedure code must be prior authorized and are priced manually during the authorization process. Manually priced items for clients who are birth through 20 years of age require prior authorization that must be obtained through the TMHP SMPA Department. The reimbursement will be determined based on either the MSRP less 18 percent or based on the provider’s documented invoice cost. Manually priced items are indicated with “MP” in the reimbursement rate table at the end of this article.
Texas Medicaid implemented mandated rate reductions for certain services. The OFL and static fee schedules include a column titled “Adjusted Fee” to display the individual fees with all mandated percentage reductions applied. Additional information about rate changes is available on the TMHP website at www.tmhp.com/pages/topics/rates.aspx.
Providers may refer to the OFL or the applicable fee schedule on the TMHP website at www.tmhp.com.

Texas Medicaid & Healthcare Partnership
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