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

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

Interpreter Services

Interpretative services may be covered, whether done orally or through sign language. Interpreters must provide only interpretation services for the agency. The services must facilitate access to Medicaid covered services.

In order for interpretation services to be covered by Iowa Medicaid, the services must meet the following criteria: 

♦ Provided by interpreters who provide only interpretive services 

♦ Interpreters may be employed or contracted by the billing provider

♦ The interpretive services must facilitate access to Medicaid covered services

Providers may only bill for these services if offered in conjunction with an otherwise Medicaid covered service. Medical staff that are bilingual are not reimbursed for the interpretation but only for their medical services

a. Documentation of the Service

The billing provider must document in the member’s record the: 

♦ Interpreter’s name or company, 

♦ Date and time of the interpretation, 

♦ Service duration (time in and time out), and 

♦ Cost of providing the service.

b. Qualifications

It is the responsibility of the billing provider to determine the interpreter’s competency. Sign language interpreters should be licensed pursuant to 645 Iowa Administrative Code 361. Oral interpreters should be guided by the standards developed by the National Council on Interpreting in Health Care.

Following is the instruction for billing interpretive services when that service is provided by an outside commercial translation service:

 Bill code T1013

  • For telephonic interpretive services use modifier “UC” to indicate that the payment should be made at a per-minute unit.

 • The lack of the UC modifier will indicate that the charge is being made for the 15 minute face-to-face unit.

♦ Enter the number of minutes actually used for the provision of the service. The 15 minute unit should be rounded up if the service is provided for 8 minutes or more.

NOTE: Because the same code is being used but a conditional modifier may be necessary, any claim where the UC modifier is NOT used and the units exceed 24 will be paid at 24 units. 

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.