Policy Statement
Our health plan processes claims for reimbursement of hearing aids, based on procedure codes, diagnoses, and documentation provided.
Coding and Billing
While a hearing aid purchase typically includes the hearing test, consultation, initial fitting, and all follow-up adjustments, routine cleanings and a warranty (from the manufacturer) that can range from one to three years, we require all future services or supplies to be billed on the actual date of service. Hearing aid warranties often cover all repairs and include a one-time replacement policy if you lose a hearing aid. If supplemental accessories, including batteries, chargers, docking stations, etc. come with the device, then they are considered included in the original purchase price of the hearing aid device itself. Items or services covered under manufacturer warranty should not be billed separately.
Monaural hearing aids: a RT or LT modifier is required for reimbursement. Claims submitted without the RT or LT modifier may be denied.
Binaural hearing aid: RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.
If a member chooses to upgrade to a hearing aid product above our reimbursement amount, the member should complete a Non-Covered Services Member Consent Form. (Note: This does not apply to BlueCard members, unless the member does not have benefits.)
In this case, providers should use HCPCS S1001 Deluxe item, patient aware (list in addition to code for basic item) when billing for the cost in excess of the standard product. The signed Non-Covered Services Member Consent Form must be on file if a request for the form at a future date.
Providers with standard (non-negotiated) agreements with Regence and suppliers can check reimbursement rates for hearing aids on Availity Essentials: Claims & Payment>Fee Schedule Listing>Fee Schedules.
This policy does not apply to surgically anchored bone conduction hearing aids. While bone conducting hearing aids meet the definition of a hearing aid, they are not in scope for this policy. Additionally, cochlear implants are not considered hearing aids under this policy, as they replace the functions of an absent or nonfunctioning cochlea rather than amplify sounds like traditional hearing aids.
The codes listed in this policy are for reference purposes only. Listing a service or device code in this policy does not imply that the service described by this code is a covered or non-covered service. Coverage is determined by the Member’s plan of benefits or Certificate of Coverage. This list of codes may not be all inclusive.
