Section 16.03.09.742 - AUDIOLOGY SERVICES: COVERAGE AND LIMITATIONSAll audiology services must be ordered by a physician or non-physician practitioner. The Department will pay for routine audiometric examination and testing once in each calendar year, and audiometric services and supplies in accordance with the following guidelines and limitations:
01.Non-Implantable Hearing Aids. When there is a documented hearing loss that meets the criteria of the Idaho Medicaid Provider Handbook, the Department will cover the purchase of non-implantable hearing aids for participants under the age of twenty-one (21) with the following requirements and limitations: a. Covered services included with the purchase of the hearing aid include proper fitting and refitting of the ear mold or aid, or both, during the first year, instructions related to the aid's use, and extended insurance coverage for two (2) years.b. The following services may be covered in addition to the purchase of the hearing aid for participants under the age of twenty-one (21): batteries purchased on a monthly basis, follow-up testing, necessary repairs resulting from normal use after the second year, and the refitting of the hearing aid or additional ear molds.c. Lost, misplaced, stolen or destroyed hearing aids are the responsibility of the participant. The Department has no responsibility for the replacement of any hearing aid. In addition, the Department has no responsibility for the repair of hearing aids that have been damaged as a result of neglect, abuse or use of the aid in a manner for which it was not intended.02.Implantable Hearing Aids. The Department may cover a surgically implantable hearing aid for participants under the age of twenty-one (21) when: a. There is a documented hearing loss as described in Subsection 742.01 of this rule;b. Non-implantable options have been tried, but have not been successful; andc. The Department has determined that a surgically implanted hearing aid is medically necessary through the prior authorization process. The Department will consider the guidelines of private and public payers, evidence-based national standards or medical practice, and the medical necessity of each participant's case.03.Provider Documentation Requirements. The following information must be documented and kept on file by the provider:a. The participant's diagnosis;b. The results of the basic comprehensive audiometric exam that include pure tone, air and bone conduction, speech reception threshold, most comfortable loudness, discrimination and impedance testing; andc. The brand name and model type of the hearing aid needed.04.Allowance to Waive Impedance Test. The Department will allow a medical doctor to waive the impedance test based on their documented judgment.Idaho Admin. Code r. 16.03.09.742