Chapter 51. Audiology Services

“Audiologist” means a professional who is licensed in accordance with Regulation .02 of this chapter who treats hearing disorders and communication problems.

“Audiology assessment” means procedures performed by an audiologist to evaluate and monitor the status of the peripheral auditory system, auditory nerve, and central auditory system, or to establish the site of the auditory disorder by using procedures to quantify and qualify hearing loss by site of lesion, on the basis of perceptual, physiological, or electrophysiological responses to acoustic stimuli, and to describe any communicative disorders.

Audiology Center.

“Audiology services” means services delivered by an audiologist to eligible participants in order to diagnose and treat hearing problems.

“Auditory osseointegrated device” means a device implanted in the skull that replaces the function of the middle ear and provides mechanical energy to the cochlea via a mechanical transducer.

“Bilateral” means relating to or involving both ears.

“Cochlear implant” means a device that is implanted under the skin that picks up sounds and converts them to impulses transmitted to electrodes placed in the cochlea, restoring some hearing to people with a hearing impairment.

“Department” means the Maryland Department of Health, the single State agency designated to administer the Medical Assistance Program under Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

“Designee” means any entity designated to act on behalf of the Department.

“Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)” means the provision of preventive health care under 42 CFR §441.50 et seq., including medical and dental services, in order to assess growth and development and to detect and treat health problems in Medical Assistance eligible individuals under 21 years old.

“EPSDT screening provider” means a physician, audiologist, or an authorized practitioner under Health Occupations Article, Annotated Code of Maryland.

“Hearing aid” means an instrument or device that is designed for improving or correcting impaired human hearing, or any part or accessory of the instrument or device.

“Hearing aid dispenser” means a person who is licensed in accordance with Regulation .02 of this chapter to sell hearing aids or provide other hearing aid services.

“Hearing aid evaluation” means services provided to a participant by an audiologist for determining the benefit of hearing aids and, upon the audiologist’s recommendation, the dispensing of hearing aids.

“Maryland Medical Assistance Program (Program)” means the program of comprehensive medical and other health-related care for indigent and medically indigent individuals.

“Medically necessary” means that the service or benefit is:

“Participant” means an individual who is enrolled with the Department to receive Medical Assistance services.

“Program” has the meaning stated in COMAR 10.09.36.01.

“Provider” means an audiologist, audiology center, or hearing aid dispenser that is licensed and that, through an agreement with the Department, has been identified as a Program provider by the issuance of a provider number.

“Unilateral” means relating to, involving, or affecting one ear.

State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists to dispense hearing aids and hearing aid accessories, as defined in Health Occupations Article, Title 2, Annotated Code of Maryland; or

Appropriate licensing body in the jurisdiction in which the hearing aids are dispensed.

Shall meet the licensure requirements in accordance with Regulation .02 of this chapter; and

May not knowingly employ another person to provide services to Maryland Medical Assistance Program participants after that person has been disqualified from the Program unless prior approval has been received from the Department.

For participants who are at risk for or have a hearing impairment, audiology assessments using procedures appropriate for the participant’s developmental age and abilities; and

Hearing aid evaluations and routine follow-up for participants with an identified hearing impairment, who currently use or are being considered for hearing aids; and

Unilateral or bilateral hearing aids which are medically necessary and are:

Hearing aid accessories and services, as listed below:

Cochlear implants and related services, as listed below:

Auditory osseointegrated device or devices and related services, as listed below:

Unless the time limitation is waived by the Program, one audiology assessment per year;

The initial coverage of unilateral or bilateral hearing aids, cochlear implants, or auditory osseointegrated devices when the Department’s medical necessity criteria have been met;

One replacement of unilateral or bilateral hearing aids:

Replacement of hearing aids, cochlear implants and auditory osseointegrated device components that have been lost, stolen, or damaged beyond repair, after all warranties have expired;

Repairs and replacements that take place after all warranties have expired;

A maximum of 76 batteries per participant per 12-month period for a unilateral hearing aid or osseointegrated devices, or 152 batteries per participant per 12-month period for bilateral hearing aids or osseointegrated devices purchased from the Department not more frequently than every 6 months, and in quantities of 38 or fewer for a unilateral hearing aid, or 76 or fewer for a bilateral hearing aid;

A maximum of 238 disposable batteries for a unilateral cochlear implant per participant per 12-month period or 476 disposable batteries per 12-month period for a bilateral cochlear implant purchased not more frequently than every 6 months, and in quantities of 119 or fewer for a unilateral cochlear implant, or 238 or fewer for a bilateral cochlear implant;

Four replacement cochlear implant component rechargeable batteries per 12-month period for bilateral cochlear implants, and a maximum of two replacement rechargeable batteries for a unilateral cochlear implant per 12-month period;

Two cochlear implant replacement transmitter cables per 12-month period for bilateral cochlear implants, and a maximum of one replacement transmitter cable for a unilateral cochlear implant per 12-month period;

Two cochlear implant replacement headset cables per 12-month period for bilateral cochlear implants, and a maximum of one replacement headset cable for a unilateral cochlear implant per 12-month period;

Two replacement cochlear implant transmitting coils per 12-month period for bilateral cochlear implants, and a maximum of one replacement transmitting coil for a unilateral cochlear implant per 12-month period;

Charges for routine follow-ups and adjustments which occur more than 60 days after the dispensing of a new hearing aid; and

A maximum of two unilateral earmolds or four bilateral earmolds per 12-month period unless a larger number is determined to be medically necessary.

Services not medically necessary;

Hearing aids and accessories not medically necessary;

Cochlear implant services and external components not medically necessary;

Cochlear implant services and external components provided less than 90 days after the surgery which are covered through the initial reimbursement;

Spare or backup cochlear implant components;

Spare or back-up auditory osseointegrated device components;

Replacement of hearing aids, equipment, cochlear implant components, and auditory osseointegrated device components if the existing devices are functional, repairable, and appropriately correct or ameliorate the problem or condition;

Spare or backup hearing aids, equipment, or supplies;

Repairs to spare or backup hearing aids, cochlear implants, auditory osseointegrated devices, equipment, or supplies;

Investigational or experimental services or devices, or both;

Replacement of improperly fitted earmold or earmolds unless the:

Additional professional fees and overhead charges for a new hearing aid when a dispensing fee claim has been made to the Program; and

Loaner hearing aids.

All hearing aids;

Certain hearing aid accessories;

All cochlear implant devices and replacement components except microphone, transmitter cables, and transmitting coils;

All auditory osseointegrated devices; and

Repairs for hearing aids, cochlear implants, and auditory osseointegrated components exceeding $500.

For services rendered or initiated within 6 months from the date the preauthorization was issued; and

If the patient is an eligible participant at the time the service is rendered.

Audiology report documenting medical necessity of the hearing aids, cochlear implants or auditory osseointegrated devices;

Interpretation of the audiogram; and

Medical evaluation by a physician supporting the medical necessity of the initial hearing aids, cochlear implants, or auditory osseointegrated devices within 6 months of the preauthorization request.

The provider’s customary charge to the general public, unless the service is free to individuals not covered by Medicaid; or

The rate in accordance with the Department’s fee schedule.

Completion of forms and reports;

Broken or missed appointments; or

Professional services rendered by mail or telephone.