​​​​​​​​​​​​​​​​​​​​Guidance for Medical Pr​oviders
Hearing Aid Coverage for Children Program

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On this page:

• Covered benefits
• Application process
• Enrollment verification
• Treatment
  
• Reimbursement
• Reimbursement rates
• Contact HACCP

Covered benefits

• Hearing aids
• Supplies, including ear molds and batteries
• Medically necessary hearing aid accessories
• Audiology and related services

Application process

1. Providers may provide paper applications to interested patients. Clinics may email HACCP to request paper applications (in both English and Spanish) for distribution.
2. Patients may apply online​ or mail or fax their application form directly to HACCP, and must include all required documentation:
• Household income
• Existing health coverage (if any)
• Hearing aid prescription or provider referral​
  
3. Eligibility will be determined within 10 days from receipt of complete application. HACCP will confirm the applicant's enrollment status to them by mail.
4. Providers are not d​irectly involved in the intake or processing of HACCP applications.

Enrollment verification

• Enrolled HACCP patients will have a program identification card
• The program ID card says “Hearing Aid Coverage for Children Program" in large type on the front of the card
• Providers may verify a patient's enrollment status in DHCS' Automated Eligibility Verification System (AEVS) using their ID number
• The patient's AEVS record will display an alert that the patient is eligible only for HACCP-covered benefits rather than full-scope Medi-Cal

Treatment

Getting hearin​​g aids

• Refer HACCP patients to a Medi-Cal enrolled audiologist to dispense hearing aids
• Provide clinical information including the prescription and the audiology report
  

Treatment Authorizati​on Request (TAR) process

• Enrollment and receipt of HACCP ID card does not imply TAR approval
• HACCP follows Medi-C​al policies, including TAR requirements to support appropriate use of covered benefits
• Some benefits always require a TAR for medical necessity, while others only require a TAR after a certain quantity
• Hearing aids always require an approved TAR
• Ear molds only require a TAR if your child needs more than two ear molds at a time, or more than four ear molds per year
• DHCS anticipates responding to most TARs within 30 days of receipt

TAR supporting d​​ocumentation

• For new hearing aids, your child's Medi-Cal enrolled audiologist needs to include these documents when they submit the TAR:
• Hearing aid prescription from an otolaryngologist (or the attending physician if no otolaryngologist is available in the community)
• Signed medical history and physical examination by an otolaryngologist
• Signed audiologic report and hearing aid evaluation
• Specification of ear to be fitted

Reimbursement

Only enrolled Fee-For-Service (FFS) Medi-Cal providers may submit claims for HACCP-covered benefits

• If you are interested in enrolling as a Medi-Cal provider, you can learn more and apply online​.
  

Providers should follow FFS Medi-Cal claims procedures, including any prerequisite Treatment Authorization Requests (TARs) for related billing codes

For services covered by patient's insurance:

• Bill the patient's primary insurance policy
• Follow that insurance policy's rules regarding copay, deductible, prior authorization, etc.

For HACCP-eligible services not covered by patient's insurance:

• Follow FFS Medi-Cal TAR and claims procedures
• Do not collect payment from the patient for HACCP-covered services
  

​Reimbursement for replacement hearing aid batteries

1. Procedure code:
• Z5822 - Hearing aid battery (modifier NU; TAR generally not required, unless utilization exceeds 96/ear within a year).
• L8621 - Zinc air battery for BCHDs
2. Quantity of units billed should be the number of battery cells dispensed (rather than indicating the number of packages, which come in assorted quantities).
3. Price per unit billed should be the cost to the provider of one (1) individual battery cell.
4. Attachment: The supplier's invoice must be submitted with the provider's claim, and must include sufficient detail to determine the cost of a single battery cell (which should match the price per unit referenced in #3).​
   

Reimbursement rates

• HACCP reimbursement is at the applicable fee-for-service Medi-Cal rate for the same procedure code.
• A complete list of procedure codes for HACCP-covered benefits is included in the HACCP Provider Manual.