System Update and Upcoming Changes to MaineCare Benefits Manual, Section 35 Hearing Aids & Services

January 22, 2014

Effective January 22, 2014, the system has been updated to allow digital hearing aid codes to be billed retroactively to January 1, 2014. Hearing aid service providers must bill in accordance with Section 35, Hearing Aids and Services. Digital hearing aids must be purchased using the State of Maine Division of Purchases’ vendors. The vendors are contracted through the Hearing Aid Procurement Program as the sole suppliers of all digital hearing aids for MaineCare members under the age of 21 with no Medicare or other third party coverage. Contracted hearing aid vendors and pricing information can be found at: http://www.maine.gov/purchases/contracts/hearingaids.shtml. Digital hearing aids dispensed on or after January 1, 2014 can be billed with the following codes:

Procedure Code Description Maximum Allowance • V5090: DISPENSING FEE, UNSPECIFIED HEARING AID $120.00

• V5110: DISPENSING FEE, BILATERAL, $170.00

• V5160: DISPENSING FEE, BINAURAL $170.00

• V5200: DISPENSING FEE, CROS $120.00

• V5240: DISPENSING FEE, BICROS $170.00

• V5241: DISPENSING FEE, MONAURAL HEARING AID, ANY TYPE $120.00

• V5246: HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, MONAURAL, ITE (IN THE EAR) By Invoice

• V5252: HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, ITE By Invoice

• V5253: HEARING AID, DIGITALLY PROGRAMMABLE, BINAURAL, BTE By Invoice

• V5256: HEARING AID, DIGITAL, MONAURAL, ITE By Invoice

• V5257: HEARING AID, DIGITAL, MONAURAL, BTE By Invoice

• V5260: HEARING AID, DIGITAL, BINAURAL, ITE By Invoice

• V5261: HEARING AID, DIGITAL, BINAURAL, BTE By Invoice

*Please note that the hearing aid policy will be updated in a few months to reflect these changes.

Please contact your Provider Relations Specialist with questions.