Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street Boston, MA 02111 www.mass.gov/masshealth

TO:
FROM:
RE:

MASSHEALTH
TRANSMITTAL LETTER AUD-11
April 2004
Audiologists Participating in MassHealth Beth Waldman, Director, Office of Medicaid Audiologist Manual (Changes to Program Regulation)

This letter transmits revisions to the Audiologist Manual program regulations. These revisions are effective for dates of service on or after May 1, 2004.
If you wish to obtain a fee schedule, you may purchase Division of Health Care Finance and Policy regulations from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). You must contact them first to find out the price of the regulation. The Division of Health Care Finance and Policy also has the regulations available on disk. The regulation title for audiologist services is 114.3 CMR 39.00: Audiological Services. The regulation title for hearing aid dispensing services is 114.3 CMR 23.00: Hearing Aid Dispensers.

Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.gov/sec/spr
Changes to the Audiologist Regulations

Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp

Effective October 1, 2003, the Division pays for office visits for evaluation and management services when certain procedures are required and provided as part of the office visit. These procedures include minor office repairs for which the provider customarily charges non-MassHealth patients, cleaning of the hearing aid, and the replacement of parts such as tubing and battery doors.
These visits are billable under Service Code 99499, at one unit per service provided. For example, if two hearing aids are cleaned for one member during one visit, two units of Service Code 99499 may be billed. If one hearing aid cleaning and two battery door replacements are provided, three units of Service Code 99499 may be billed.
Effective for dates of service beginning May 1, 2004, MassHealth will pay for a maximum of six units of service per member per date of service.
These regulations are effective May 1, 2004.

MASSHEALTH
TRANSMITTAL LETTER AUD-11 April 2004 Page 2
NEW MATERIAL
(The pages listed here contain new or revised language.)
Audiologist Manual
Pages vii, 4-7, 4-8, 6-3, and 6-4
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Audiologist Manual
Pages vii, 4-7, 4-8, 6-3 and 6-4 — transmitted by Transmittal Letter AUD-10

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
AUDIOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
PREFACE	PAGE
vii	

	TRANSMITTAL LETTER
AUD-11	DATE
05/01/04	
The regulations and instructions, governing provider participation in MassHealth are published in the Provider Manual Series. MassHealth publishes a separate manual for each provider type.
Manuals in the series contain administrative regulations, billing regulations, program regulations, service codes, descriptions, billing instructions, and general information. MassHealth’s regulations are incorporated into the Code of Massachusetts Regulations (CMR), a collection of regulations promulgated by state agencies within the Commonwealth and by the Secretary of State. MassHealth regulations are assigned Title 130 of the Code. The regulations governing provider participation in MassHealth are assigned Chapters 400 through 499 within Title 130. Pages that contain regulatory material have a CMR chapter number in the banner beneath the subchapter number and title.
Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals.
Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For audiologists, those matters are covered in 130 CMR Chapter 426.000, reproduced as Subchapter 4 in the Audiologist Manual.
Revisions and additions to the manual are made as needed by means of transmittal letters, which furnish instructions for making changes by hand ("pen-and-ink" revisions), and by substituting, adding, or removing pages. Some transmittal letters will be directed to all providers; others will be addressed to providers in specific provider types. In this way, a provider will receive all those transmittal letters that affect its manual, but no others.
The Provider Manual Series is intended for the convenience of providers. Neither this nor any other manual can or should contain every federal and state law and regulation that might affect a provider's participation in MassHealth. The provider manuals represent instead MassHealth's effort to give each provider a single convenient source for the essential information providers need in their routine interaction with MassHealth and with its members.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
AUDIOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 426.000)	PAGE
4-7	

	TRANSMITTAL LETTER
AUD-11	DATE
05/01/04	
426.416: Reimbursable Services
(A)	Complete Audiological Evaluation. Payment for a complete audiological evaluation will be made only if the evaluation is recommended by a physician.
(B)	Hearing-Aid Purchase. Payment for a hearing-aid purchase includes the following:

(1)	the hearing aid and standard accessories/options required for the proper operation of the hearing aid;
(2)	the proper fitting and instruction in the use, care, and maintenance of the hearing aid;
(3)	the maintenance, minor repair, and servicing provided during the operational lifetime of the hearing aid that is furnished free of charge to non-MassHealth patients;
(4)	the initial one-year manufacturer's warranty against loss or damage; and
(5)	the loan to the member of a hearing aid by the audiologist, when necessary.
(C)	Earmold. An earmold is not reimbursable if it is included in the manufacturer's price of the
hearing aid or if the member already has an appropriate earmold. Payment for an earmold
includes the following:
(1)	the proper fitting of the earmold; and
(2)	any adjustments that may be needed during the operational life of the earmold.
(D)	Ear Impression.
(1)	For a Hearing Aid. Payment for an ear impression for a hearing aid includes one properly formed ear impression for each in-the-ear hearing aid purchased. The provider may not claim payment for an ear impression for a hearing aid until the hearing aid has actually been delivered to the member.
(2)	For an Earmold. The provider may not claim payment for an ear impression for an earmold until the earmold has actually been delivered to the member.
(E)	Batteries. Batteries must be new at the time of purchase.
(F)	Accessories. Payment for accessories and hearing-aid options includes proper fitting and
adjustment of the accessory as needed. Accessories must be billed separately from the basic
hearing-aid unit. The costs of accessories, such as audio input cords and telephone coils, must be
combined into one single total charge and billed as one unit of service.
(G)	Major Repairs. The provider of a repair service is responsible for the quality of the
workmanship and parts, and for ensuring that the repaired hearing aid is in proper working
condition. The audiologist is responsible for ensuring that the repaired hearing aid is in proper
working condition upon returning the aid to the member. Payment for a major repair to a hearing
aid is limited to the following conditions.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
AUDIOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
4 PROGRAM REGULATIONS (130 CMR 426.000)	PAGE
4-8	

	TRANSMITTAL LETTER
AUD-11	DATE
05/01/04	
(1)	All warranties and insurance must have expired.
(2)	The hearing aid must be sent directly to the repair facility or manufacturer that will perform the repair. (The handling charges of an intermediary are not reimbursable.)
(3)	The repair service must include a written warranty against all defects for a minimum of six months.
(4)	A copy of the invoice from the repair facility or manufacturer for the cost of the repair must accompany the claim form.
(H) Office Visits for Evaluation and Management Services. MassHealth pays for an office visit for evaluation and management services only when one or more of the following services is required and is provided as part of the visit:
(1)	minor adjustments to the hearing aid to assure a proper fitting, such as an earmold adjustment, when the provider is not the provider who initially fit the hearing aid, and the provider who initially fit the hearing aid is no longer a MassHealth provider;
(2)	minor office repairs for which the provider customarily charges non-MassHealth patients;
(3)	cleaning of the hearing aid; or
(4)	replacement of parts such as, but not limited to, tubing, hooks, battery doors, and recasing.
(I) Refitting Services/Other Professional Services. MassHealth pays for additional fitting/refitting services only where the hearing aid was dispensed more than two years prior to the date of service of the refitting services. These professional services include refitting of the aid, orientation, counseling with the member or member’s family, contact with interpreters, fitting of a loaner aid, and similar services. Payment for these services must include a face-to-face encounter with the member. Payment is made for a maximum of three visits per year.
(J) Cochlear Implant Service Contract. MassHealth pays for a service/maintenance contract from the manufacturer of a cochlear implant device that is approved by the U.S. Department of Health and Human Services Food and Drug Administration (FDA), which covers certain costs for repair and replacement parts for an eligible member’s existing cochlear implant system. This does not include contracts for the sole purpose of replacement due to loss, theft, or accidental damage. The following restrictions apply to the service contract.
(1)	The service contract must be for a minimum period of two years, paid in full with the enrollment. MassHealth does not pay for a service contract purchased under an installment payment plan, where payment in full at enrollment is also an option.
(2)	The service contract, when available as a combined option, must include repair and replacement coverage for both the headpiece and speech processor.
(3)	The service contract is not covered until the manufacturer’s original warranty, which is
obtained at the time of initial implantation, expires.
(4)	A copy of the invoice from the manufacturer for the cost of the service contract must
accompany the claim form.

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
AUDIOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-3	

	TRANSMITTAL LETTER
AUD-11	DATE
05/01/04	
601   Service Codes and Descriptions (cont.)
Service
Code-Modifier	Service Description
HEARING AID SERVICES
Office Visits for Evaluation and Management Services
99499	Unlisted evaluation and management service (up to a maximum of six services per
member per date of service). (Providers may submit a prior-authorization request pursuant to 130 CMR 450.144(A) for members under 21 for units in excess of six per member per date of service.)
Refitting Services/Other Professional Services
V5011	Fitting/orientation/checking of hearing aid
Hearing Aid Purchases-Monaural
V5030	Hearing aid, monaural, body worn, air conduction (P.A. if cost exceeds $500) (I.C.)
V5040	Hearing aid, monaural, body worn, bone conduction (P.A. if cost exceeds $500) (I.C.)
V5050	Hearing aid, monaural, in the ear (P.A. if cost exceeds $500) (I.C.)
V5060	Hearing aid, monaural, behind the ear (P.A. if cost exceeds $500) (I.C.)
V5246	Hearing aid, digitally programmable analog, monaural, ITE (in the ear) (P.A. if cost
exceeds $500) (I.C.)
V5247	Hearing aid, digitally programmable analog, monaural, BTE (behind the ear) (P.A. if cost
exceeds $500) (I.C.)
V5256	Hearing aid, digital, monaural, ITE (P.A. if cost exceeds $500) (I.C.)
V5257	Hearing aid, digital, monaural, BTE (P.A. if cost exceeds $500) (I.C.)
Hearing Aid Purchases-Binaural
V5130	Binaural, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5140	Binaural, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5150	Binaural, glasses (P.A. if cost exceeds $1,000) (I.C.)
V5252	Hearing aid, digitally programmable, binaural, ITE (P.A. if cost exceeds $1,000) (I.C.)
V5253	Hearing aid, digitally programmable, binaural, BTE (P.A. if cost exceeds $1,000) (I.C.)
V5260	Hearing aid, digital, binaural, ITE (P.A. if cost exceeds $1,000) (I.C.)
V5261	Hearing aid, digital, binaural, BTE (P.A. if cost exceeds $1,000) (I.C.)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
AUDIOLOGIST MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-4	

	TRANSMITTAL LETTER
AUD-11	DATE
05/01/04	
601   Service Codes and Descriptions (cont.)
Service
Code-Modifier	Service Description
Hearing Aid Purchases-CROS and BICROS
V5170	Hearing aid, CROS, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5180	Hearing aid, CROS, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5190	Hearing aid, CROS, glasses (P.A. if cost exceeds $1,000) (I.C.)
V5210	Hearing aid, BICROS, in the ear (P.A. if cost exceeds $1,000) (I.C.)
V5220	Hearing aid, BICROS, behind the ear (P.A. if cost exceeds $1,000) (I.C.)
V5230	Hearing aid, BICROS, glasses (P.A. if cost exceeds $1,000) (I.C.)
Hearing Aid Purchases-Other
V5070	Glasses, air conduction (I.C.)
V5080	Glasses, bone conduction (I.C.)
V5100	Hearing aid, bilateral, body worn (I.C.)
V5274	Assistive listening device, not otherwise specified (I.C.) (Use this code only for pocket-
talkers.)
V5298	Hearing aid, not otherwise classified (P.A.) (I.C.)
Hearing Aid Repairs, Accessories, and Related Services
V5014	Repair/modification of a hearing aid (I.C.)
V5264	Ear mold/insert, not disposable, any type (I.C.)
V5265	Ear mold/insert, disposable, any type (I.C.)
V5266	Battery for use in hearing device (per battery)
V5267	Hearing aid supplies/accessories (I.C.)
V5275	Ear impression, each
V5299	Hearing service, miscellaneous (P.A.) (I.C.)
Hearing Aid Dispensing Fees
V5160	Dispensing fee, binaural
V5200	Dispensing fee, CROS
V5240	Dispensing fee, BICROS
V5241	Dispensing fee, monaural hearing aid, any type