This section provides policy and billing information for hearing aid service providers including audiologists and hearing instrument dispensers.
Hearing Aid Volume Purchase Contract
All hearing aids must be purchased directly from manufacturers participating on the Hearing Aid Volume Purchase Contract. Hearing aid service providers are paid the contract price plus a dispensing fee. Hearing aids must:
Hearing aids that do not prove satisfactory to a user are to be returned to the manufacturer within 90 days from the date the hearing aid is provided to the recipient at no cost to DHS/MHCP or the hearing aid dealer. The hearing aid volume purchase contract requires that:
Hearing aids do not include ear molds and accessories not included in the cost of the hearing aid but that are necessary to the recipient’s use of the hearing aid:
No extra charge may be made for:
Manufacturers will not process hearing aid orders unless all authorization requirements are met.
Hearing Aids Not on Volume Purchase Contract List (Non-contract aids)
Hearing aid service providers must provide hearing aids under the terms of the volume purchase contract. If the audiologist prescribes a non-contract hearing aid, the hearing aid service provider must obtain authorization by providing either:
The hearing aid service provider who bills for the repair of a non-contract aid must obtain and include the purchase date and the purchase warranty expiration date of the hearing aid from the manufacturer. If the aid is under warranty, MHCP will not reimburse providers or manufacturers for repairs or the cost of returning the aid to the manufacturer.
MHCP will reimburse the hearing aid service provider one dispensing fee for fitting and dispensing a monaural or set of binaural hearing aids for a recipient. Claims are not eligible for payment until after the hearing aid is dispensed. The dispensing fee includes:
Providers may submit dispensing fee claims when providing replacement hearing aids. If a dispensing fee has already been paid, authorization is required. For example, providers may bill (with authorization) an additional dispensing fee when hearing aids are replaced under the loss and damage warranty. No additional dispensing fee is payable for replacing an unsatisfactory hearing aid(s) during the required trial period.
Hearing aids obtained under the volume purchase contract that are not satisfactory to the user may be returned to the manufacturer within 90 days after the dispensing date, but no sooner than 30 days. The trial period consists of consecutive days beginning the day the hearing aid is provided to the recipient and must extend at least 30 days, but no more than 90 days. The hearing aid service provider must inform the recipient of the beginning and ending dates of the trial period, and refer the recipient to the prescribing audiologist when the aid cannot be adjusted to the recipient's satisfaction. If the audiologist prescribes a hearing aid to replace the unsatisfactory aid, the hearing aid service provider must order the prescribed replacement aid.
MHCP covers one hearing aid or set of binaural hearing aids within a period of five years for an eligible recipient. If hearing aids must be replaced due to change in hearing, or hearing aid loss, theft, or irreparable damage, the provider must request authorization for a new aid. MHCP considers the recipient's physical or mental impairment in determining whether circumstances were beyond the recipient's control if the aid is lost or broken and will only approve a replacement in those cases.
Always verify recipient eligibility (PDF) and prior receipt of a hearing aid(s) before dispensing or requesting an authorization.
MHCP will not replace a lost, stolen or broken hearing aid when MHCP has replaced a hearing aid twice within the five-year period previous to the date of request. Per federal requirements, this replacement policy does not apply to children under 21. In cases when MHCP does not provide a replacement hearing aid, the hearing aid service provider may provide the eligible recipient with a contract hearing aid at the contract price. The hearing aid and dispensing fee will be paid by the recipient.
Documentation Requirements and Approval Criteria
The following documentation requirements for medical records apply regardless of whether or not the hearing aid requires authorization. This information must also be attached to authorization forms, if authorization is required:
Before providers are reimbursed for hearing aid assessments or dispensing, a physician, physician assistant or nurse practitioner must rule out medical or surgical indications contrary to fitting the recipient with a hearing aid. The medical clearance must be performed within six months prior to dispensing. After ruling out contraindications, the physician then refers the recipient for an audiologic evaluation to determine if a hearing aid is necessary. An audiologist or otolaryngologist must provide the audiologic testing and if a hearing aid is indicated, prescribe a specific hearing aid offered under the hearing aid volume purchase contract. An individual who is enrolled as a hearing aid dispenser, but is not an audiologist or otolaryngologist, may not perform audiologic evaluations or prescribe hearing devices.
The hearing aid service provider must dispense the hearing aid according to the hearing aid exam, selection, and prescription of the otolaryngologist and audiologist. The recipient shall see an audiologist within the hearing aid trial period so that the audiologist may determine the effectiveness of the hearing aid.
Out-of-state hearing aid service providers (including audiologists) who do not sell hearing aids/instruments in Minnesota must comply with licensing/certification requirements of the other state, but are not required to be certified in Minnesota.
All MHCP recipients except recipients of programs with limited benefit sets such as Emergency Medical Assistance (EMA). Refer to “Benefits by Programs” charts in Health Care Programs and Services.
Hearing aid services are an MHCP covered service; in addition to dispensing hearing aids, hearing aid services include:
MHCP does not reimburse hearing aid service providers separately for audiologic evaluations, hearing aid exams and selection, or home visits.
Authorization is required for all hearing systems other than personal hearing aids; i.e. cochlear implants(s), bone anchored hearing aids.
Hearing aid batteries may not, at one time, be dispensed in a quantity that exceeds a 90-day supply. Hearing aid batteries may not be dispensed unless the recipient is in need of the batteries and requested them. Batteries may be dispensed on the same date as the hearing aid is dispensed. However, the dispensing service must include the provision of at least three batteries.
Ear impressions needed for the purpose of custom making an in-the-ear (ITE) hearing aid and ear molds for behind-the-ear (BTE) hearing aids are reimbursed as a separate service from the dispensing fee.
Replacement ear molds for BTE hearing aids are covered, including open dome style ear molds (not disposable) that are replaced about every 3 months.
Hearing aid checks, including setting and resetting volume, programming and reprogramming and other adjustments of digital and digitally programmable hearing aids, are billable services only after the hearing aid trial period. Hearing aid checks are limited to four checks per year. Claims for hearing aid checks with date of service prior to 90 days following the day of service for dispensing new aids will deny.
Hearing aid accessories such as chest harnesses, telecoils, and tone and ear hooks are covered when not included in the price of the hearing aid. Check the contract for hearing aid features included in the price.
Programming/reprogramming and other adjustments of digital and digitally programmable hearing aids are billable services only after the hearing aid trial period. See “Hearing Aid Checks” above.
Re-casing, remakes and shell modifications are billable services. Providers must include a description of the service provided. For example, when billing a shell modification, the provider must describe the:
Provide the manufacturer’s invoice with the claim when billing a re-case or remake.
Battery door replacements are billable. Providers must include a description of this service on the claim.
Submit authorization requests and documentation to the authorization medical review agent.
When systems such as FM systems, vibrotactile devices, cochlear implants or personal communicators (e.g., pocket talkers) are requested, justification is needed, just as for non-contract aids. The audiologist must also address each of the following points:
Bill services on the MN–ITS (837P) Professional. For further billing instructions, please refer to the Billing Policy section of the manual and the MN–ITS User Guide for Hearing Aids.
Audiologists and hearing instrument dispensers in private practice
Claims are payable to the provider in private practice, i.e., audiologist or hearing instrument dispenser.
Group practice/facility billing: For purposes of billing hearing instrument dispensing services, group practice or facility are defined as outpatient hospitals, clinics, corporation or partnerships and other health care providers who employ audiologists, otolaryngologists and/or hearing instrument dispensers – see definition under Eligible Providers
Claims are payable to the group practice/facility:
Note: Follow billing instructions above for service provided by audiologists or hearing instrument dispensers in private practice who also work part-time in a facility setting. Determine the setting where the dispensing services were provided and follow the instructions for either private practice or group practice/facility billing.
Claims for hearing aid purchases must include:
Do not bill accessories included with the initial hearing aid purchase.
Recipient’s binaural hearing aid consists of matching hearing aid models
Bill the binaural set using the appropriate binaural code, 1 unit, and other required modifiers (NU) and billing information
Recipient’s binaural hearing aid consists of two different hearing aid models, dispensed on the same day
Bill each hearing aid model with appropriate monaural procedure code, 1 unit and other required modifiers (LT, RT, NU) and billing information
Recipient’s binaural hearing aid consists of two different hearing aids, dispensed on different dates of services. Authorization is required for the second aid (and dispensing fee) if the DOS are more than 6 months apart.
Bill each aid with appropriate monaural code, 1 unit, and required modifiers (LT, RT, NU) modifiers. Second claim will deny due to recipient’s benefits exhausted. Contact provider help desk for assistance if DOS is less than 6 months from provision of first hearing aid. Authorization is required for the second aid (and dispensing fee) if the DOS are more than 6 months apart.
During trial period, hearing aid(s) prove unsatisfactory to recipient
Provider has billed for unsatisfactory aid(s)
Provider has not billed for unsatisfactory aid(s)
Hearing aid repairs consist of parts and labor required to maintain the operation of the hearing instrument.
Claims must include:
Use to billing the following:
Bill hearing aid batteries in quantities of one unit per battery. Providers may bill replacement batteries in quantities not exceeding a quantity necessary to operate the hearing aid for a period of not more than 90 days, beginning with the date the hearing aid is dispensed.
The current listing of manufacturers and hearing aid models, and past hearing aid contracts dating back to 2005, are available online through the Hearing Aid Dispensers home page, under Resources Documents and Forms.
Hearing aid checks may not be billed during hearing aid trial period. Bill hearing aid checks according to the provider type providing the service (treating provider):
Monaural hearing aid check. Service includes cleaning; do not bill cleaning separately, See Audiology Service Thresholds
Binaural hearing aid check. Service includes cleaning; do not bill cleaning separately. See Audiology Service Thresholds
Hearing Instrument Dispenser
Monaural hearing aid check: bill 1 unit
Audiologic Evaluation: An assessment administered by an audiologist or otolaryngologist to evaluate communication problems caused by hearing loss
Dispensing Audiologist: An audiologist who meets the requirements of MS 148.515
Hearing Aid: A monaural hearing aid, set of binaural hearing aids, or other device worn by the recipient to improve access to and use of auditory information
Hearing Aid Accessory: Chest harnesses, tone and ear hooks, carrying cases, and other accessories necessary to use the hearing aid, but not included in the cost of the hearing aid
Hearing Aid Service Provider: A person who meets the requirements of MS 153A and is certified by the Department of Health as a hearing instrument dispenser
Hearing Aid Services: Services to dispense hearing aids and provide hearing aid accessories and repairs
Otolaryngologist: A physician specializing in diseases of the ear and larynx who is certified by the American Board of Otolaryngology or eligible for board certification
MS 148.515 Qualifications for Licensure
MS 153A Hearing Instrument Dispensing
MS 256B.0625, subd.8; subd.8a; subd.8c Covered Services PT, OT, SLP
MS 256B.0625, subd.31a Aug. Communication Devices
Minnesota Rules 4658.0525 Rehabilitative Nursing Care
Minnesota Rules 9505.0175 Definitions
Minnesota Rules 9505.0210 Covered Services, General Requirements
Minnesota Rules 9505.0220 Health Services not covered by Medical Assistance
Minnesota Rules 9505.0287 Hearing Aid Services
Minnesota Rules 9505.0385 Rehabilitation Agency Services
Minnesota Rules 9505.0386 Comprehensive Outpatient Rehabilitation Facilities
Minnesota Rules 9505.0390 Rehabilitative and Therapeutic Services
Minnesota Rules 9505.0391 Therapists Eligible to Enroll as Providers
Minnesota Rules 9505.0392 Compliance with Medicare Requirements
Minnesota Rules 9505.0410 Long-Term Care Facilities; Rehabilitative and Therapeutic Services to Residents
Minnesota Rules 9505.0411 Long-Term Care Facilities; Rehabilitative and Therapeutic Services to Non-Residents
42 CFR 440.110
42 CFR 483.45
42 CFR sub. H, 485.701 to 485.729
42 CFR sub. D, 486.150 to 486.163
CPT codes, descriptions and other data only are copyright 2002 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.