Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
This is an update to the current Texas Medicaid Provider Procedures Manual, Vision and Hearing Services Handbook, Section 22.214.171.124, “Non-implantable Hearing Aid Devices.” The language regarding invoice submissions was revised and will be updated with the April 2019 release.
The revised statement is as follows:
Providers must not use usual and customary fees as the amount billed. The documentation submitted with the claim must be a manufacturer invoice showing the net acquisition cost of the non-implantable hearing aid device. An original invoice with manufacturer name must be submitted. Invoice templates are not acceptable. Model number, serial number, and warranty expiration date must be included.
For more information, call the TMHP Contact Center at 800-925-9126.