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



On this page:

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 directly 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
  • 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 rates

​​
Type Procedure Code Description Rate
AudiologyV5010Assessment for hearing aid$52.70
AudiologyV5264Ear mold/insert, not disposable, any type$27.52
AudiologyV5265Ear mold/insert, disposable, any typeBy report
AudiologyX4500Diagnostic audiological evaluation, including pure tone audiometry, speech reception threshold, and discrimination$66.05
AudiologyX4501Pure tone audiometry (with complete audiogram)$35.79
AudiologyX4522Evoked response audiometry test, physician evaluation$160.10
AudiologyX4526Hearing therapy (individual) per hour$45.40
AudiologyX4530Impedance audiometry (bilateral)$33.14
AudiologyX4532Electroacoustic analysis of hearing aid as a monaural procedure$23.32
AudiologyX4535Unlisted audiological servicesBy report
AudiologyX4540Tympanometry$22.94
AudiologyX4542Electroacoustic analysis of hearing aid as a binaural procedure$42.81
AudiologyX4544Diagnostic evaluation for severely physically/mentally handicapped person over age 7$84.75
Hearing AidV5014Repair/modification of a hearing aid (modifier RB)*
Hearing AidV5030Hearing aid, monaural, body worn, aid conduction*
Hearing AidV5040Hearing aid, monaural, body worn, bone conduction*
Hearing AidV5050Hearing aid, monaural, in the ear*
Hearing AidV5060Hearing aid, monaural, behind the ear*
Hearing AidV5070Glasses; air conduction*
Hearing AidV5080Glasses; bone conduction*
Hearing AidV5120Binaural; body aid*
Hearing AidV5130Binaural; in the ear aid*
Hearing AidV5140Binaural; behind the ear aid*
Hearing AidV5150Binaural; glasses aid*
Hearing AidV5171Hearing aid, contralateral routing system, monaural, in the ear (ITE)*
Hearing AidV5172Hearing aid, contralateral routing system, monaural, in the canal (TC)*
Hearing AidV5181Hearing aid, contralateral routing system, monaural, behind the ear (BTE)*
Hearing AidV5190Hearing aid, contralateral routing, monaural, glasses*
Hearing AidV5211Hearing aid, contralateral routing system, binaural, ITE/ITE*
Hearing AidV5212Hearing aid, contralateral routing system, binaural, ITE/ITC*
Hearing AidV5213Hearing aid, contralateral routing system, binaural, ITE/BTE*
Hearing AidV5214Hearing aid, contralateral routing system, binaural, ITC/ITC*
Hearing AidV5215Hearing aid, contralateral routing system, binaural, ITC/BTE*
Hearing AidV5221Hearing aid, contralateral routing system, binaural, BTE/BTE*
Hearing AidV5230Hearing aid, contralateral routing system, binaural, glasses*
Hearing AidV5264
Ear mold/insert, not disposable, any type$27.52
Hearing AidV5265Ear mold/insert, disposable, any typeBy report
Hearing AidV5267Hearing aid supply/accessory*
Hearing Aid
V5298Hearing aid, not otherwise classified*
​Hearing Aid
​Z5822
​Hearing aid batteries, replacement
​​By report
Outpatient
99202-99215Otolaryngologist/physician outpatient office visit**
Outpatient99417Otolaryngologist/physician outpatient office visit**
Outpatient
99241-99245Otolaryngologist/physician outpatient consultation

**

​Bone conduction hearing devices (BCHDs)”

​L8691
​Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each
​***
​​Bone conduction hearing devices (BCHDs)

L8692
​Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment
​***
​​Bone conduction hearing devices (BCHDs)
L86924
​Auditory osseointegrated device, transducer/actuator, replacement only, each
​***

*See Hearing Aids: Billing Codes and Reimbursement Rates section of the Medi-Cal Provider Manual.​​

**See Medi-Cal Rates webpage.​

***See Audiological Services section of the Medi-Cal Provider Manual.

Contact HACCP

Phone (Multilingual, TTY/TTD)
1 (833) 956-2878
Hours
Monday through Friday, 8 AM to 7 PM
Saturday, 8 AM to 12 PM
Email
HACCP@maximus.com

Last modified date: 9/30/2022 11:29 AM