QUEST Integration – Hearing Aids

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

HMSA’s Plan for QUEST Integration Members covers hearing aids to correct hearing loss. Referral to an ENT specialist is required to determine if otologic disorders are associated with hearing loss. Only one hearing aid evaluation is covered in a 12-month period. Referrals are not needed to purchase hearing aid supplies, including but not limited to batteries, tubing, nubbins and ear molds, or for repairs.

Covered Features

Hearing aids must be either unilateral or binaural and offer standard features such as a manual or set screw volume and tone control adjuster. They also may include single channel programmable devices and one or more of the following:

• Stacked V.C. cap
• Windscreen
• Retention hook
• Removal notches/handle
• Hypoallergenic shell coating
• Flex canal
• Model color
• Hearing aid insurance for children age 12 years and younger

Patients are responsible for the additional costs related to non-covered items such as:

• Digital programming
• Rush service
• Feedback control
• Extended warranty
• Telecoil
• Tinnitus maskers

Note:

Hearing aids are covered once in a 24-month period. Precertification is required for all hearing aids. A replacement is payable only if the current hearing aid is beyond repair or needs frequent repairs.

Claims Filing Information

Please refer to the QUEST Integration – Instructions for Completing CMS 1500 Claim Form and the information below for specific hearing aids. In Block 24D, be sure to record the following:

• Modifier: Enter LT (left) or RT (right) to the left of the dotted line.
• Procedure Code: Enter appropriate procedure code below to indicate the appliance provided:

Returns

If a newly dispensed hearing aid is returned by the patient, any payment by QUEST Integration for the hearing aid should be returned to HMSA’s Plan for QUEST Integration Members. See instructions for QUEST Integration – Refunding HMSA.

Precertification/Fee Schedule

Precertification is required for all hearing aids. A maximum fee of $1,300.00 for monaural hearing aids is payable.

ENT results and audiological test results must be submitted with the precertification request. If precertification is approved, use procedure codes V5130 (in the ear) or V5140 (behind the ear).

Send requests for precertification to:

Pre-authorization Unit

HMSA – Medical Management Department

P.O. Box 2001

Honolulu, HI  96805

– or –

Fax: 808-944-5611

Revision History