Newborn Hearing Screening

The Colorado legislature passed House Bill 97-1095, which establishes hearing screenings for newborn infants [25-4-1004.7(VI)(b)]. Appropriate testing and identification of newborn infants with hearing loss makes early intervention and treatment possible and promotes the healthy development of children. 

Hearing Conservation Program (HCP) Audiology Regional Coordinators provide consultation information, technical assistance, and referral services to families of children with special health care needs.

Newborn Hearing Screening Reimbursement Policy

1. For inpatient hospital deliveries, reimbursement for newborn hearing screening is included in the hospital DRG for the delivery. CPT/HCPCS codes for hearing screening cannot be billed for dates on or during the date span of the delivery hospital stay. 

a. Hospitals have been given responsibility for newborn hearing testing; therefore, Medicaid will not provide reimbursement in addition to that included in the DRG rate for services rendered in the inpatient hospital setting, including newborn nurseries or NICU. 

2. For freestanding birth center deliveries or home births, reimbursement for newborn hearing screening may be billed using CPT/HCPCS codes for hearing screening. These codes may be billed for dates on or during the same date span of the delivery.

3. Follow-up screening for newborns who fail their initial hearing screening may be billed using CPT/HCPCS codes. Follow-up screens may be billed only if they occur on dates of service outside of the date span for the delivery hospital admission. Newborn hearing screenings are a Preventive Service, but that designation does not supersede the reimbursement policies listed above.

Cochlear Implants 

1. Cochlear implants are covered for clients aged 12 months through 20 years under the following criteria: 

a. Limited benefit from appropriately fitted binaural hearing aids (with different definitions of “limited benefit” for children four (4) years of age or younger and those older than four (4) years) and a three (3) to six (6) month hearing aid trial. 

b. Bilateral hearing loss with unaided pure tone average thresholds of 70 dB or greater. 

c. Minimal speech perception measured using recorded standardized stimuli-speech discrimination scores of 50-60% or below with optimal amplification at 1000, 2000 and 4000 Hz. 

d. Family support and motivation to participate in a post-cochlear aural, auditory and speech language rehabilitation program. 

e. Assessment by an audiologist and otolaryngologist experienced in cochlear implants. 

f. Bi lateral and hybrid/Electric Acoustic Stimulation cochlear implantation considered on a case by case basis.

g. No medical contraindications. 

h. Up-to-date-immunization status as determined by the Advisory Committee on Immunization Practices (ACIP) 

2. Replacement component(s) of an existing cochlear implant is a benefit for all ages when the currently used component(s) is no longer functional and cannot be repaired.