Mont. Admin. R. 37.86.702 - AUDIOLOGY SERVICES, SERVICE REQUIREMENTS, AND RESTRICTIONS
(1) The following requirements and
restrictions apply for purposes of coverage and reimbursement of audiology
services under the Montana Medicaid program.
(2) Audiology services are hearing aid
evaluations and basic audio assessments provided within the scope of practice
permitted by state law to recipients with hearing disorders. Audiology services
must be provided by a licensed practitioner within the scope of the practice
permitted by state law. The provider's records maintained under ARM
37.85.414 must demonstrate the
medical necessity for the service, and compliance with applicable supervision
and protocol requirements.
(3) Audiology services may be provided to a
recipient only upon a current written or verbal order or referral by a
physician or mid-level practitioner. All verbal orders or referrals must be
followed up by a written order received by the provider within 30 days of the
verbal order or referral.
(a) The provider is
not entitled to Medicaid reimbursement if services are provided prior to actual
receipt of the written or verbal order or referral. Referrals and orders are
valid for Medicaid purposes for no more than 90 days.
(b) The provider must maintain the referral
or order of the physician or mid-level practitioner and appropriate records
that demonstrate compliance with Medicaid requirements. The provider must
provide copies of these documents at no charge to the department or its agents
upon request.
(4) In
addition to the requirements of ARM 37.85.414, a provider must maintain the
written orders of the physician or mid-level practitioner and all diagnostic
and evaluative reports. The provider must provide copies of these documents at
no charge to the department or its agents upon request.
(5) The audiology services must be required
as preliminary steps to obtaining a medically necessary hearing aid or device
for the recipient.
(6) Basic audio
assessments must include for each ear under earphones:
(a) Pure tone air conduction thresholds at
the frequencies of.5, 1, 2, 3, and 4 KHZ;
(b) Speech reception threshold; and
(c) Speech discrimination (word recognition)
test under phonetically-balanced (PB) max conditions, and either pure tone bone
conduction thresholds at the frequencies specified in (6)(a), or tympanometry,
including tympanogram, acoustic reflexes, and static compliance.
(7) Medicaid reimbursement for a
basic audio assessment or a hearing aid evaluation includes all related
supplies and items used in the performance of the assessment or
evaluation.
Notes
53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA;
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