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Binaural hearing loss diagnostic codes1/30/2024 The person must then go to a Connecticut Medicaid participating hearing aid vendor (audiologist/hearing aid dealer) for testing and possible hearing aids.Medicaid beneficiary must get a prescription from a physician stating that the person is a candidate for hearing aid(s).Hearing aids are covered after a medical evaluation by a licensed practitioner. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility.Pregnant women if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy and.Hearing exams and testing of hearing aids to see if they are working are not covered with the following exceptions:.Prior authorization is required for the purchase or trial period rental of hearing aids and for repairs that cost more than $25 per repair service.Hearing aids must be supplied by a hearing aid dispenser on the prescription of an otolaryngologist, or the attending physician.Follow-up care for cochlear implants themselves is covered for pregnant women, or people who live in a nursing home or sub-acute facility. Testing, exam, or follow-up for cochlear implants.Replacement of lost, stolen or irreparably damaged hearing aids.Hearing exams and hearing aids, repair of hearing aids, and replacement of hearing aid parts.These services must be determined medically necessary, prescribed, and ordered by a physician or other licensed health care practitioner trained to administer hearing assessments and evaluations within the scope of the practitioner’s license. State Medicaid Coverage of Hearing Services for Adults (21 and older).Īudiology, diagnostic testing, hearing therapy, rehabilitative therapy, hearing aids (including approved accessories and supplies), and hearing item repairs. These hearing services must be provided periodically at intervals that meet reasonable standards of medical practice.īecause of this national requirement for coverage of children, the compilation below delineates only the Medicaid coverage for adults. Medically necessary hearing aid services, including hearing aids and hearing aid accessories and services.Specifically, EPSDT covers the following medically necessary audiological services for children who are at risk for hearing impairment: A state must provide to Medicaid beneficiaries under age 21 hearing services, including appropriate screening, diagnostic, and treatment, including hearing aids. EPSDT services are mandated for children from birth through age 21. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.ĮPSDT is the child health component under Medicaid (42 U.S.C. Since the states often make revisions to the scope of their Medicaid benefits, recipients are cautioned to check their state’s Medicaid offices for possible updated coverage. Compiled below is the coverage of hearing aids and related services made available to eligible Medicaid recipients in each state.
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