Vibrotactile Aids (V5999)

A vibrotactile aid is covered when the member has a diagnosis of bilateral profound sensory-neural hearing loss and little or no benefit from amplification. Reimbursement is invoice priced.

The member records must document: 

♦ The member’s hearing condition 

♦ Waiver of a medical evaluation for members 21 years of age and over 

♦ Results of the hearing testing 

♦ Results of the hearing aid evaluation and selection

D. PROCEDURE CODES AND NOMENCLATURE

Medicaid recognizes Medicare’s National Level II Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes. However, all HCPCS and CPT codes are not covered.

Providers who do not have Internet access can obtain a copy of the providerspecific fee schedule upon request from the IME.

It is the provider’s responsibility to select the procedure code that best describes the item dispensed. A claim submitted without a procedure code and a corresponding diagnosis code will be denied.

Modifiers                     Description 

52                               Test applied to one ear instead of two ears 

EP                              Services performed as the result of an EPSDT (early periodic screening,                                           diagnosis and treatment) exam 

LT                              Left 

RT                              Right 

SC                              Sometimes covered by Medicare 

U3                              Nursing home dispensing fee 

U5                              In-house repairs 

UC                             Telephone translation 

BILLING POLICIES AND CLAIM FORM INSTRUCTIONS

Claims for Audiologists and Hearing Aid Dispensers are billed on federal form CMS-1500, Health Insurance Claim Form.