PA Lookup
If you have questions about prior authorizations, please call:
Member and Recipient Service Line: 1-877-685-2415
Provider Support Service Line: 1-855-250-1539
Youth sized disposable incontinence product, protective underwear/pull-on, each
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel
How to Submit
N/A - No authorization is required
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC
How to Submit
N/A - No authorization is required
Hearing screening
Authorization Guidelines
The prior approval process is deemed met by the IEP, IFSP, IHP, BIP or 504 Plan processes.
How to Submit
Please submit your request to Trillium Health Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Binaural, glasses
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing aid, contralateral routing, monaural, glasses
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Dispensing fee, contralateral, monaural
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Hearing aid, contralateral routing system, binaural, ITE/ITC
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing Aid Services
The NC Medicaid (Medicaid) programs provide hearing aids, FM systems, hearing aid accessories and supplies, and dispensing fees when there is medical necessity. Note: This policy does not address cochlear or auditory brainstem implant coverage. For eligible beneficiaries with profound hearing impairment requiring cochlear or auditory brainstem implantation, refer to clinical coverage policy 1A-4, Cochlear and Auditory Brainstem Implants.
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Limits
The beneficiary shall receive a medical examination from a physician (including otologist, otolaryngologist and otorhinolaryngologist) and documentation of medical clearance for the initiation of the hearing aid selection process. Covered only for beneficiaries under 21 years of age under Medicaid.
A current medical clearance must be based on a medical evaluation within the preceding six months.
The beneficiary must be given a 30 calendar-day trial period before the post-dispensing evaluation.
The dispensing claim can only be billed after the post-dispensing evaluation, which should generally occur within 30 days after dispensing.
The new hearing aid dispense includes at least one year of service and regular maintenance at no extra cost.
The initial month supply of batteries is included and cannot be billed separately. Replacement requests are subject to review of the frequency of other replacements.
If the replacement aid is under the manufacturer's warranty and loss and damage policy, a dispensing fee cannot be billed when the manufacturer pays a dispensing fee to the provider for the replacement.ill one unit per battery claim.
Reimbursement is limited to up to $35 per battery claim.
Up to six battery claims per year do not require prior approval; additional battery claims require prior approval.
The initial one-month supply of batteries furnished with a new hearing aid cannot be billed separately. Medicaid does not cover hearing aid services, including FM systems, for beneficiaries 21 years of age and older.
FM systems for educational purposes are expected to be provided by public school systems starting at age three under IDEA; Medicaid consideration is for FM systems not covered through IDEA.
Claims for a new FM system must be accompanied by an invoice.
- • Ear mold claims must be accompanied by an invoice.
- • Accessory claims must be accompanied by an invoice or invoices.
- • For accessory claims with multiple invoices, bill one unit with the combined invoice total and one dispensing fee.
- • An ear mold dispensing fee cannot be billed on a new hearing aid claim.
- • A separate dispensing fee cannot be billed for ear molds or accessories that are components of new hearing aids
Exclusions
Non-covered hearing aid products and services include:
- a. battery charger or tester
- b. adapter for telephone, television, or radio
- c. shipping, handling, postage, or insurance fee
- d. loss and damage insurance
- e. in-the-ear hearing aid that is requested for primarily cosmetic purpose
- f. extended warranty policy
This list is not all inclusive. Replacement hearing aid requests may be denied when loss or damage is due to improper care or negligence, because improper care or negligence does not constitute extenuating circumstances. Prior approval is not required for up to six battery claims per year, with a maximum of $35 per claim. If additional batteries are needed beyond six claims per year, the provider shall submit an electronic prior approval request with documentation of medical necessity. Each such request is reviewed on a case-by-case basis. Batteries supplied as the initial one-month supply with a new hearing aid are not separately billable because they are included as a component of the new hearing aid dispense.FM systems used for educational purposes that are covered by public school systems under IDEA are not the Medicaid-covered scenario addressed for FM system prior approval; Medicaid consideration is for FM systems not covered through IDEA.
Diagnosis Requirements
Covered hearing aid products and services include hearing aids and dispensing fees. Newly fit binaural hearing aids require a medical examination and medical clearance from a physician to initiate the hearing aid selection process, plus a hearing evaluation by a licensed audiologist including an audiogram. The prior approval package for new hearing aids must include the initial hearing evaluation, audiogram, hearing aid selection results, and written evaluation. If the devices requested are digital programmable hearing aids, the prior approval request must also include documentation of medical necessity.
Age Group Details
Medicaid shall not cover Hearing Aid Services for beneficiaries 21 years of age and older
Place of Service
Inpatient hospital (21), outpatient hospital (22), comprehensive outpatient rehabilitation facility (62), office (11), state or local public health clinics (71), rural health clinics (72), and home (12).
Additional Service Specifics
The provider shall obtain prior approval by submitting an electronic prior approval request at http://www.nctracks.nc.gov for all hearing aids, FM systems, care kits, repairs,accessories, custom ear molds, replacement parts, batteries in excess of six claims per year with a maximum of $35 per claim, and dispensing fees.
Prior approval requests for hearing aids must include the hearing aid manufacturer’s name, model name or number, style (body, BTE, etc.), type (analog or digital programmable, etc.) and the estimated invoice cost
How to Submit
Please submit your request to Carolina Complete Health through Availity
Resources
Hearing aid, disposable, any type, monaural
Authorization Guidelines
See the Carolina Complete Health site for specific requirements
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
How to Submit
Please submit your request to Carolina Complete Health through Availity
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