E-204 Non-Covered Services

Services for which medical necessity is not clearly established are not covered by the Department’s Medical Programs

In addition, the following services are excluded from coverage in the Department’s Medical Programs and payment cannot be made for the provision of these services:

• Routine periodic exams in the absence of an identified problem. 

• Examination required for the determination of disability or incapacity. (Local Department of Human Services offices may request that such examinations be provided with payment authorized from non-medical funds. Audiologists are to follow specific billing instructions given when such a request is made.) 

• Expenses associated with postage and handling for any items. 

• Travel expenses to provide testing. 

• Batteries in a long term care setting.

Note: No separate additional charge is to be made for freight, postage, delivery, instruction, fitting, adjustments or measurement, since these services are considered to be inclusive in a provider’s dispensing fee charge. These additional charges cannot be billed to the patient.

E-205 Record Requirements

The Department regards the maintenance of adequate medical records as essential for the delivery of quality medical care. In addition, providers should be aware that medical records are a key document for post payment audits. 

In the absence of proper and complete medical records, no payment will be made and payments previously made will be recouped. Lack of records or falsification of records may also be cause for a referral to the appropriate law enforcement agency for further action. 

Providers must maintain an office record for each patient. In group practices, partnerships, and other shared practices, one record must be kept with chronological entries by the individual provider rendering services. 

The record maintained by the audiologist must include the essential details of the patient’s condition and of each service or item provided. Any services provided to a patient by the audiologist outside the audiologist’s office are to be documented in the medical record maintained in the audiologist’s office. All entries must include the date and must be legible. Records which are unsuitable because of illegibility or language may result in sanctions if an audit is conducted. 

For patients who are in a nursing facility, the primary medical record indicating the patient’s condition, treatment, and services ordered and provided during the period of institutionalization may be maintained as a part of the of the facility chart; however, an abstract of the facility record, including diagnosis, treatment program, dates and times services were provided, must be maintained by the audiologist as an office record to show continuity of care.

General Policy and Procedures, an audiologist’s records are to include the following information:

• A copy of the referral from the Practitioner (otologist, otolaryngologist, primary care physician, Advanced Practice Nurse or Physician Assistant).

• A copy of the manufacturer’s invoice with the patient’s name and hearing aid serial number. 

• Hearing aid evaluation results.

• Diagnosis. 

• Audiogram.

• Medical history relevant to audiology services. 

• Dates services or items were provided. 

• A copy of the manufacturer’s invoice for an ear mold, if applicable.