Hearing
Aid Dealer is recognized in Kentucky Medicaid as Provider Type 50. In
order to enroll as a Hearing Aid Dealer with Kentucky Medicaid, see the Kentucky Medicaid Provider Enrollment website.
Covered Services
Eligible services are medically necessary, limited to one complete hearing evaluation per the calendar year and may include a hearing instrument evaluation which includes three follow-up visits:
Within the six-month period immediately following fitting with a hearing instrument; and
Related to the proper fit and adjustment of the hearing instrument including one additional follow-up visit at least six months following the hearing instrument fitting and related to the proper fit and adjustment of the hearing instrument.
Additional services may be included if the beneficiaries' health care provider demonstrate that an additional hearing instrument evaluation is medically necessary.
Hearing instrument model that is recommended by a licensed audiologist pursuant to KRS 334A.030; and available through a Medicaid-participating specialist in hearing instruments and not to exceed $1200 per ear every thirty-six (36) months.
Hearing aid dealers must meet the coverage provisions and requirements of
907 KAR 1:038 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations. All services must be medically necessary.
Non-Covered Services
The department will not cover a hearing instrument if a hearing examination of a recipient by a physician, and a recommendation for a hearing instrument for the recipient by an audiologist is done prior to the fitting of a hearing instrument.
The department will not reimburse more than 24 batteries (12 per ear) per month and must be consistent with the manufacturer's recommendations and at regular intervals as necessary to ensure optimal function of the hearing device.
Verifying eligibility
Verify eligibility by calling the automated voice response system at (800) 807-130 or by using the web-based KYHealth-Net System.
Reimbursement
Reimbursement for Hearing
Aid Dealer is listed on the Kentucky Medicaid Audiology Fee Schedule which can be found on the Fee and Rates Schedule Home Page.
Reimbursement for Hearing
Aid Dealer is defined in regulation 907 KAR 1:039.
A provider may request coverage for a CPT or HCPCS procedure code by submitting a request in writing to the department which includes necessity, CPT or HCPCS code, and expected reimbursement. Any codes considered experimental are not covered by Kentucky Medicaid.
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.
Prior Authorizations
Each MCO provides prior authorization for its beneficiaries.
Gainwell
Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries.
For more information, visit Prior Authorizations.
Claims Submission
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Coding
Kentucky Medicaid requires Hearing Aid Dealer providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal
requests for denied FFS claims must be submitted to Gainwell Technologies.
The request must include the Provider Inquiry Form, reason
for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO claim.
Timely Filing
Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Provider Inquiry Resources
- Billing Questions- Gainwell Technologies, (800) 807-1232, ky_provider_inquiry@gainwelltechnologies.com
- Provider Questions- (855) 824-5615
- Prior Authorization- Gainwell Technologies, (800) 292-2392, (800) 644-5725, (800) 807-8842
- Provider Enrollment, Maintenance, and Revalidation- (877) 838-5085
- KYHealth.net assistance- Gainwell Technologies, (800) 205-4696, ky_edi_helpdesk@gainwelltechnolgies.com
- Pharmacy Questions- (502) 564-6890, dmsweb@ky.gov
- Pharmacy Clinical Support Questions- (800) 477-3071
- Pharmacy Prior Authorization- (844) 336-2676
- Physician Administered Drug (PAD) list- (502) 564-6890
Managed Care Organizations
*Effective Jan. 1, 2025, Anthem is no longer an active Medicaid Managed Care Organization, or MCO, in Kentucky. However, they are responsible for the payment of claims, appeals, or disputes for dates of service up to and including Dec. 31, 2024.