Hearing Aids

Hearing aids are a covered benefit for members ages 20 and under and for adult members on the Supported Living Services (SLS) Waiver.

When billing for a pair of hearing aids, each individual hearing aid must be listed on a separate line on the claim form and must have the appropriate modifier noted to indicate the ear for which it is fitted. The “RT” modifier indicates the hearing aid is for the right ear, and the “LT” modifier indicates it is for the left ear. Billing for two (2) units of a hearing aid, on the same line, without the appropriate modifier will result in a denial.

Hearing Aid Trial Rental Period 

The Trial Rental Period is included in the purchase reimbursement for the hearing aid(s). Use the last day of the rental period as the date of service.

 Hearing Aid Replacement 

Hearing aids are expected to last 3 – 5 years. Replacement of a hearing aid is covered for members ages 20 and under. Hearing aids may be replaced when they no longer fit, have been lost or stolen, or the current hearing aid is no longer medically appropriate for the child. 

Ear Molds

Reimbursement for ear molds is included in the dispensing fee (procedure code V5090) charged in conjunction with the hearing aid code. Ear molds are not independently reimbursable, and are not a covered benefit for noise reduction or swimming. 

Softbands (including Bone Anchored Hearing Aids - BAHAs) 

Softband hearing devices (including BAHAs) are a covered benefit for members ages 20 and under. All softband purchases require a PAR and must be accompanied by a signed letter from a physician documenting medical necessity. In addition, claims must be submitted on the CMS 1500 paper claim form and include the invoice received for purchasing the item. The Colorado Medical Assistance Program reimburses softband devices using the following methodology: invoice cost + 10%. Please see the table below for a list of procedure codes covered for softband devices. 

All Audiology PARs and revisions processed by the ColoradoPAR Program must be submitted through eQSuite®. Clinical information is required for a PAR review. When submitting PARs, please answer the clinical questions in eQSuite®, attach the relevant clinical documentation needed for determinations, and select “Medical” type from the drop-down menu. If “DME” is selected this will result in non-payment of the device.