The following information provides clarification on reimbursement and prior authorization for hearing aids and associated services.
WSI reimbursement methodology:
- If there is a fee schedule amount listed, the service is reimbursed accordingly.
- If U&C is indicated on the fee schedule, the service is reimbursed according to the 50th percentile of the usual, customary and reasonable rate (UCR) of the geographic area.
Providers should obtain prior authorization from the claims adjuster before dispensing hearing aids. Replacement hearing aids are covered when medically necessary and approved by the claims adjuster. Other associated covered costs may include dispensing fee, batteries and hearing aid exam. Charges should be billed with appropriate HCPCS codes on a CMS 1500.
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