Coverage for Hearing Aids and Auditory Implants

April 23rd, 2019 - Brandon Dee Leavitt QCC, CMCS, CPC, EMT
Categories:   Billing   Emergency Medicine   ENT|Otolaryngology   Surgical Billing & Coding   Neurology|Neurosurgery   Pediatrics   Primary Care|Family Care  
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For hearing impairment, Medicare is firm in its stance on when it will and will not cover hearing correction. In the PUB 100-02 Medicare Benefit Policy Manual, Chapter 16, Medicare cites the Social Security Act by explaining:

 "..."hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids" are excluded from coverage."

So, hearing aids will not be covered when the purpose is strictly limited to hearing correction without certain complications. Medicare classifies hearing aids as:

"...amplifying devices that compensate for impaired hearing. Hearing aids include air conduction devices that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound. They also include bone conduction devices that provide mechanical energy to the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles."

However, there are certain cases of coverage Medicare indicates are allowed.

"Certain devices that produce perception of sound by replacing the function of the middle ear, cochlea or auditory nerve are payable by Medicare as prosthetic devices. These devices are indicated only when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss or surgery."

"Medical and hospital services are sometimes required to treat a condition that arises as a result of services that are not covered because they are determined to be not reasonable and necessary or because they are excluded from coverage for other reasons.... (e.g., cosmetic surgery, non-covered organ transplants, non-covered artificial organ implants, etc.)....,

"However, any subsequent services that could be expected to have been incorporated into a global fee are not covered. Thus, where a patient undergoes cosmetic surgery and the treatment regimen calls for a series of postoperative visits to the surgeon for evaluating the patient's progress, these visits are not covered."

And what prosthetic devices are covered? These are the devices listed in PUB 100:

"Cochlear implants and auditory brainstem implants, i.e., devices that replace the function of cochlear structures or auditory nerve and provide electrical energy to auditory nerve fibers and other neural tissue via implanted electrode arrays.

"Osseointegrated implants, i.e., devices implanted in the skull that replace the function of the middle ear and provide mechanical energy to the cochlea via a mechanical transducer."

Essentially, these are cases where hearing correction is reimbursed:

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