Coverage

Monaural or binaural hearing aids

 The agency covers new, nonrefurbished, monaural or binaural hearing aid(s), which includes the ear mold and batteries, for eligible clients age 20 and younger. In order for the provider to receive payment, the hearing aid must meet the client's specific hearing needs and be under warranty for a minimum of one year. 

Replacement 

The agency pays for the following replacements as long as the need for replacements is not due to the client’s carelessness, negligence, recklessness, or misuse in accordance with WAC 182- 501-0050(8): 

• Hearing aid(s), which includes the ear mold, when all warranties are expired and the hearing aid(s) are one of the following: 
• Lost 
• Beyond repair 
• Not sufficient for the client's hearing loss 
• Ear mold(s) when the client's existing ear mold is damaged or no longer fits the client's ear. 
• Batteries with a valid prescription from an audiologist. 

Repair 

The agency pays for a maximum of two repairs, per hearing aid, per year, when the repair is less than 50% of the cost of a new hearing aid. To receive payment, all the following must be met: 

• All warranties are expired. 
• The repair is under warranty for a minimum of 90 days.

Rental 

The agency pays for a rental hearing aid(s) for up to two months while the client's own hearing aid is being repaired. In the case of a rental hearing aid(s), the agency pays separately for an ear mold(s). 

Cochlear implant – replacement parts

The agency covers: 

Cochlear implant external speech processors, including maintenance, repair, and batteries.

Baha® speech processors, including maintenance, repair, and batteries. 

The agency pays for cochlear implant and Baha® replacement parts when: 

• The manufacturer's warranty has expired. 
• The part is for immediate use, not a back-up part. 
• The part needs to be replaced due to normal wear and tear and is not related to misuse or abuse of the item (see WAC 182-502-0160).

The client must pay for repairs to additional speech processors and parts. 

When reimbursing for battery packs, the agency covers the least costly, equally effective product. 

Note: The agency does not pay providers for repairs or replacements that are covered under the manufacturer’s warranty.

Replacement parts - EPA criteria 

The following expedited prior authorization (EPA) criteria must be met: 

• The cochlear implant or bone conduction (Baha®) is unilateral (bilateral requires PA). 
• The manufacturer’s warranty has expired. 
• The part is for immediate use (not a back-up part). 

Note: If the client does not meet the EPA criteria, then PA is required. 

Use EPA 870000001 with HCPCS codes L8615-L8618, L8621-L8624 when billing for cochlear implant and bone conduction (Baha®) replacement parts