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TMPPM Update for Hearing Aid Services Prior Authorization Language

Last updated on 3/17/2023

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member's specific MCO for details.

On May 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Vision and Hearing Services Handbook, section 2.2.5 “Hearing Aid Services” and section “Limitations” to add prior authorization language.

Hearing aid revisits are limited to two per calendar year by any provider. Additional hearing aid checks may be reimbursed with prior authorization.

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