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 . ..