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The Centers for Medicare and Medicaid Services (CMS) has revised its hearing aid definition so that auditory osseointegrated and auditory brainstem implant (ABI) devices and related services are clearly covered under Medicare as prosthetic devices. The revised policy, published on Nov. 10, resulted from information provided by ASHA's Health Care Economics Committee and coordinated by Robert Fifer.
Change Request 4038, Pub 100-02, Transmittal 39 of the CMS Manual System, can be found at http://www.cms.hhs.gov/Transmittals/downloads/R39BP.pdf (PDF format). Effective Dec. 12, the updated Medicare policy states that prosthetic devices now include "osseointegrated implants to the mastoid process of the temporal bone and auditory brainstem devices." Auditory osseointegrated devices are appropriate for patients with bilateral external ear malformations such as atresia. ABI devices are for patients who are deafened due to bilateral acoustic neuromas or neurofibromas.
A revised definition of hearing aids and auditory implants in the Medicare Benefit Policy Manual, Chapter 16, section 100, describes air conduction and bone conduction hearing aids. Now, it also describes specific devices that replace the function of the middle ear, cochlea, or auditory nerve as prosthetic devices that are payable by Medicare.
CMS limits coverage to those Medicare beneficiaries "when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss, or surgery." Medicare carriers are directed to pay for the covered physician services related to these prosthetic devices using current procedural terminology (CPT) and healthcare common procedure coding system (HCPCS) codes. Carriers and intermediaries are further directed to use other codes, when appropriate, should they become available.
The ASHA Health Care Economics Committee has developed and submitted a proposal for a new CPT code that would allow audiologists to bill for the programming of ABI devices. The request for a new code will be presented to the CPT Editorial Panel in February 2006. For more information, contact Steven White, ASHA's director of health care economics and advocacy, at swhite@asha.org or at 800-498-2071, ext. 4126.
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