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LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

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SHARS Updates to Audiology Services Under Section 504 Plan

Last updated on 9/14/2021

This article has been updated. For the updated information, click here.

Note: Implementation is pending Centers for Medicare & Medicaid Services (CMS) approval. The Texas Health and Human Services Commission (HHSC) is requesting an October 1, 2021 effective date. In the event of delayed CMS approval, HHSC will issue an updated notice to SHARS providers with additional information.

In accordance with Texas Education Code §38.033 (2019; 86(R) H.B. 706), relating to the eligibility of certain children who are deaf or hard of hearing for audiology services under the School Health and Related Services (SHARS) program, HHSC is required to implement policy updates to eligibility criteria for certain audiology services.

The following updates for SHARS audiology services are pending CMS approval, with a requested effective date of October 1, 2021:

Additional Provisions Under the SHARS Program

Additional provisions under the SHARS program will allow SHARS providers to receive reimbursement for audiology evaluation and management services delivered to Medicaid-eligible students under Section 504, Rehabilitation Act of 1973 (29 U.S. Code Section 794) mandated by Texas Education Code §38.033 (2019; 86(R) H.B. 706), as approved by CMS.

SHARS Eligibility Criteria for Audiology Services Under Section 504 Plan

Medicaid-eligible students for whom these services are billed must meet all eligibility requirements listed in the Texas Medicaid Provider Procedures Manual (TMPPM) SHARS Handbook and must have the following plan and referral:

A written Section 504 plan, documenting disability and medical necessity
A referral for audiology evaluation and management services

A Section 504 plan is mandated by 29 U.S. Code Section 794, regulated by Code of Federal Regulations (CFR) §104, and developed by the school, in conjunction with the parents or guardians, teachers, and school administration. The plan must include evaluation data along with placement information regarding the type of services the student needs.

Evaluation under a Section 504 plan may be conducted using the same process to evaluate the needs of students under the Individuals with Disabilities in Education Act (IDEA). If school districts choose to adopt a separate process for evaluating students under a Section 504 plan, CFR §104.35 must be followed.

The SHARS program will not reimburse providers for services under a Section 504 plan beyond audiology evaluation and management services.

Procedure Codes and Modifiers

Licensed audiologists may be reimbursed for the following benefits for eligible students with IEP or Section 504 plans:

Audiology Evaluation Procedure Codes
- New SHARS billable procedure codes
  - Pure tone audiometry (Procedure code 92553)
  - Speech audiometry threshold (Procedure code 92556)
  - Comprehensive audiometry (Procedure code 92557)
  - Audiology evaluation add-on (Procedure code 92621)
- Existing SHARS billable procedure codes
  - Audiology evaluation – first hour (Procedure code 92620)
Audiology Management Procedure Codes
- New SHARS billable procedure codes
  - Hearing aid check – one ear (Procedure code 92592)
  - Hearing aid check – two ears (Procedure code 92593)
Modifiers – The following modifiers must be used when billing any of the procedure codes listed above:
- TM – To be used when billing for audiology evaluation and management services provided to students with Individualized Education Program (IEP).
- U4 – To be used when billing for audiology evaluation and management services provided to students with Section 504 plan.
Documentation Requirements - All previous service log documentation requirements for SHARS services apply to audiology evaluation and management services covered under Section 504 plans.
Parental Consent for Reimbursement - All previous requirements for obtaining parental consent prior to disclosing student information or billing Medicaid for SHARS services apply to audiology evaluation and management services covered under Section 504 plans.

Notes:

This change applies ONLY to the specific SHARS Audiology Evaluation and Management procedure codes referred to in this notice.
Students with Section 504 plans are not eligible for any other SHARS services.

For more information, call the TMHP Contact Center at 800-925-9126.