Vision and Hearing Services Handbook

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Texas Medicaid Provider Procedures Manual October 2019 Provider Handbooks Vision and Hearing Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health and Human Services Commission. Table of Contents 1 General Information . 5 1.1 Payment Window Reimbursement Guidelines for Services Preceding an Inpatient Admission. 5 2 Nonimplantable Hearing Aid Devices and Related Services . 6 2.1 Enrollment . 6 2.1.1 School Districts, State Agencies, and Inpatient Facilities. 6 2.2 Services, Benefits, Limitations, and Prior Authorization. 6 2.2.1 Limitations and Required Forms . 7 2.2.2 Hearing Screenings. 7 2.2.2.1 Routine Hearing Screenings. 7 2.2.2.2 Additional Hearing Screenings . 8 2.2.2.3 Abnormal Hearing Screening Results . 8 2.2.3 Audiology and Audiometry Evaluation and Diagnostic Services . 8 2.2.3.1 Otological Examinations . 9 2.2.3.2 Vestibular Evaluations . 9 2.2.3.3 Evaluative and Therapeutic Services. 9 2.2.3.4 Intraoperative Neurophysiology Monitoring (IONM) . 10 2.2.3.5 Forms and Documentation . 10 2.2.3.6 Prior Authorization . 10 2.2.3.7 Limitations . 10 2.2.3.8 SHARS Audiology Services . 11 2.2.3.9 Noncovered Services . 12 2.2.4 Hearing Aid Devices and Accessories (Nonimplantable). 12 2.2.4.1 Forms and Documentation . 14 2.2.4.2 Prior Authorization . 14 2.2.4.3 Limitations . 15 2.2.5 Hearing Aid Services. 16 2.2.5.1 Forms and Documentation . 17 2.2.5.2 Prior Authorization . 18 2.2.5.3 Limitations . 18 2.3 Documentation Requirements . .19 2.4 Claims Filing and Reimbursement . .19 2.4.1 Claims Filing . 19 2.4.1.1 Non-implantable Hearing Aid Devices. 20 2.4.1.2 Third Party Liability . 20 2.4.2 Reimbursement . 20 2.4.2.1 National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) Guidelines . 21 3 Implantable Hearing Devices and Related Services . .21 3.1 Enrollment . .21 3.2 Services, Benefits, Limitations and Prior Authorization . .21 3.2.1 Cochlear Implants . 22 3.2.1.1 Prior Authorization . 22 3.2.1.2 Limitations . 23 3.2.1.3 Auditory Rehabilitation . 23 3.2.2 Auditory Brainstem Implant (ABI) . 24 3.2.2.1 Prior Authorization . 24 VISION AND HEARING SERVICES HANDBOOK OCTOBER 2019 3.2.2.2 Limitations . 24 3.2.3 Bone-Anchored Hearing Device (BAHD) . 25 3.2.3.1 Prior Authorization . 25 3.2.3.2 Limitations . 25 3.2.4 Sound Processor Replacement and Repair. 26 3.2.4.1 Prior Authorization . 26 3.2.4.2 Limitations . 26 3.2.5 Electromagnetic Bone Conduction Hearing Device - Removal Only. 26 3.3 Documentation Requirements . .26 3.4 Claims Filing and Reimbursement . .26 3.4.1 Claims Filing . 26 3.4.1.1 Third Party Liability . 27 3.4.2 Reimbursement . 27 3.4.2.1 NCCI and MUE Guidelines. 27 4 Vision Care Professionals . .28 4.1 Enrollment . .28 4.2 * Provider Responsibilities. .28 4.3 Services, Benefits, Limitations, and Prior Authorization. .28 4.3.1 Services Performed in Long-Term Care Facilities . ..

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LCD): Computerized Corneal Topography (L33810
Local Coverage Determination (LCD): Computerized Corneal Topography (L33810) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT NUMBER JURISDICTION STATE(S) First Coast Service Options, Inc. A and B MAC 09102 - MAC B J - N Florida First Coast Service Options, Inc. A and B MAC 09202 - MAC B J - N Puerto Rico First Coast Service Options, Inc. A and B MAC 09302 - MAC B J - N Virgin Islands LCD Information Document Information LCD ID Original Effective Date L33810 For services performed on or after 10/01/2015 LCD Title Revision Effective Date Computerized Corneal Topography For services performed on or after 01/08/2019 Proposed LCD in Comment Period Revision Ending Date N/A N/A Source Proposed LCD Retirement Date N/A N/A AMA CPT / ADA CDT / AHA NUBC Copyright Notice Period Start Date Statement N/A CPT codes, descriptions and other data only are copyright 2019 American Medical Association. All Rights Notice Period End Date Reserved. Applicable FARS/HHSARS apply. N/A Current Dental Terminology © 2019 American Dental Association. All rights reserved. Copyright © 2019, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any Created on 01/02/2020. Page 1 of 7 software, product, service, solution or derivative work without the written consent of the AHA.
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Division of Health Care Financing & Policy SB 278 Section 16
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Code Procedure Cpt Price University Physicians Group
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Keratoconus and Corneal Stability After Radial Keratectomy in the Fellow Eye
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