Billing and Claim Forms (DDA Clients)

What are the general billing requirements? 

These billing requirements include: 

• The time limits for submitting and resubmitting claims and adjustments. 
• How to bill for clients eligible for both Medicare and Medicaid. 
• How to handle third-party liability claims. 
• What standards to use for record keeping. 

What records must be kept in the client’s file?

This includes, but is not limited to, the following tests: 

• Audiogram results/graphs/tracings (including air conduction and bone conduction comparisons) 
• Basic or simple hearing tests or screening, such as those done in schools 
• Tympanogram 
• Auditory brainstem response (ABR) 
• Electronystagmogram (ENG) (not a hearing test but a special test of inner ear balance) 

A valid prescription from an audiologist for replacement batteries must be kept in the client’s chart.

How do I complete the CMS-1500 claim form?

The following CMS-1500 claim form instructions relate to the Hearing Hardware program.

Field No :  23

Name : Prior Authorization Number 

Field Required : Yes

Entry : Use the social services authorization number assigned to you.

Field No :  24D

Name : Procedures, Services or Supplies CPT/HCPCS

Field Required : Yes

Entry : Enter the appropriate Current Procedural Terminology (CPT) or Common Procedure Coding System (HCPCS) procedure code for the services being billed. 

Modifier: When appropriate enter a modifier.