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Reminder for Documentation Requirements for Hearing Aid Claims Reprocessing
Information posted October 9, 2009: TMHP has identified an issue that impacts claims submitted with dates of service on or after December 2, 2008, and monaural hearing aid device procedure codes with modifier LT or RT. Claims that were appealed with appropriate documentation for a previously-reimbursed hearing aid may have been denied in error. Providers are encouraged to appeal affected claims. Click on the title to view the details.
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Reminder: If a monaural hearing aid has been reimbursed for the client within the last 5 years and modifier LT or RT was not billed on the previous claim, a second claims billed with monaural hearing device procedure codes and modifier LT or RT may be denied with explanation of benefit (EOB) code 00443 which indicates, “This service exceeds benefit limitations but may be paid with medical necessity documentation. Please appeal with appropriate documentation.” Affected claims may be appealed with documentation that indicates for which ear the previous hearing aid for the client was reimbursed. Documentation may include, but is not limited to, information noted in the client’s medical record, a receipt from the purchase of the previous hearing aid, or a statement submitted on the provider’s letterhead. A written or typed statement on the Remittance & Status (R&S) Report is not acceptable documentation. Providers may refer to the article published on April 3, 2009, on this website titled, “Some Hearing Aid Devices Claims to Be Reprocessed” for additional information.
For more information, call the TMHP Contact Center at 1-800-925-9126.
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