E-203.2 Non-Audiologist Businesses

DME providers may provide hearing aids and hearing aid-related services and items but not professional audiology services for which an audiologist’s academic credentials and licensing are required. 

Certified hearing instrument dispensers are eligible to provide hearing aid fitting, sale of the hearing aid itself, hearing aid accessories, replacement parts and repairs.

E-203.3 Hearing Aids 

Providers must charge the actual acquisition cost of the hearing aid. The actual acquisition cost is the actual payment by the supplier for the hearing aid, taking into account any discounts, rebates or bonuses. The full amount of the discount must be subtracted when calculating the actual acquisition cost. The amount of any rebates or bonuses must be prorated to all purchases on which the rebate or bonus was earned. The prorated share must be subtracted when calculating the acquisition cost of the hearing aid. 

The date of service to be submitted when billing for a hearing aid is the date the hearing aid is dispensed, not the fabrication date. The participant must be eligible on the dispensing date for providers to receive reimbursement from the Department. 

A dispensing fee may be billed at the time the hearing aid is dispensed to the patient. The dispensing fee includes, but is not limited to payment for fitting, followup visits, shipping fees and retail mark-up for the hearing aid. 

Exception: HFS covers hearing aid batteries. Allowable quantities are listed on the fee schedule. Batteries are not covered for clients who reside in a Long Term Care (LTC) facility. It is the responsibility of the LTC facility to provide its residents with batteries as the cost of the hearing aid batteries are included in the payment made by the Department to the LTC facility. 

Provision of a hearing aid, whether by an audiologist or a DME provider, must include a minimum one-year warranty at no expense to the Department. Repair costs covered by the warranty are not to be submitted to the Department for payment. 

E-203.3.1 Hearing Aid Criteria

In order to be eligible for reimbursement from the Department for hearing aids, the following criteria must be met:

When testing is performed in an acoustically treated sound suite: 

The hearing loss must be 20 decibels (dB) or  greater at any two of the following frequencies: 500, 1000, 2000, 4000, 8000 Hertz (Hz), 

or 

The hearing loss must be 25 dB or greater at any one of 500, 1000, 2000 Hz.

When testing is performed at a site other than an acoustically treated sound suite:

The hearing loss must be 30 dB or greater at any two of the following frequencies: 500, 1000, 2000, 4000, 8000 Hz,

or 

The hearing loss must be 35 dB or greater at any one of 500, 1000, 2000 Hz 

E-203.4 Early Intervention Services

Early Intervention (EI) services are covered for children up to the age of three years, who are eligible for Part C services under the Individuals with Disabilities Education Act and when those services are included in the child’s Individualized Family Service Plan. Procedure codes for EI services must be billed to the EI Central Billing Office (CBO) for payment. In order to receive payment from the CBO, a provider must apply for and obtain an Early Intervention Credential, enroll as a provider with the CBO and have prior authorization to provide services.

• For credential and enrollment information, contact Provider Connections at 1-800-701-0995. 

• For questions about the service authorization and billing processes, contact the Early Intervention CBO Cornerstone Call Center at 1-800-634-8540.