Medicine
Chapter 7
Section 8.2
Hearing Aids And Hearing
Aid Services
Issue Date: April 19, 1983
Copyright: HCPCS
Level I/CPT only © 2006 American Medical Association (or such other
date of publication of CPT). All Rights Reserved.
Revision: C-17, February 14, 2018
1.0 CPT
PROCEDURE CODE RANGE
92590 - 92595
2.0 HCPCS
PROCEDURE CODES
L8692, V5000 - V5267, V5275,
V5298
3.0 POLICY
3.1 Hearing
aids and hearing aid services and supplies may be covered for those
Active Duty Family Members (ADFMs) with a profound hearing loss
as described below. Benefits under this Section are only available
for a dependent of a member of the Uniformed Services on active
duty, to include all members covered under the Transitional Assistance
Management Program (TAMP).
3.1.1 Profound hearing loss (adult).
An “adult” (a spouse as defined in
32 CFR 199.3(b) of
a member of the Uniformed Services on active duty for more than
30 days) with a hearing threshold of:
3.1.1.1 40 dB HL
or greater in one or both ears when tested at 500, 1,000, 1,500,
2,000, 3,000, or 4,000Hz; or
3.1.1.2 26 dB HL
or greater in one or both ears at any three or more of those frequencies;
or
3.1.1.3 A speech recognition score less than 94%.
3.1.2 Profound
hearing loss (child). A “child” (an unmarried child of an active
duty member who otherwise meets the criteria (including age requirements)
in
32 CFR 199.3 of this part) with a 26dB HL
or greater hearing threshold level or one or both ears when tested
in the frequency range at 500, 1,000, 2,000, 3,000, or 4,000Hz.
3.2 Medically
necessary and appropriate services and supplies, including hearing
examinations provided by authorized providers, required in connection
with this hearing aid benefit are covered.
3.3 Repairs and Replacements.
Benefits are allowed for repair of beneficiary owned hearing aids when
it is necessary to make the hearing aid serviceable. Benefits are
allowed for replacement of beneficiary owned hearing aids when the
hearing aid is lost or is not serviceable due to normal wear, accidental
damage, or due to a change in the beneficiary’s condition, or level
of hearing loss.
4.0 EXCLUSIONS
4.1 Hearing
aid and hearing aid services for retirees and their family members,
to include TRICARE Retired Reserve (TRR) beneficiaries.
4.2 Hearing
aid and hearing aid services for TRICARE Reserve Select (TRS) beneficiaries.
Note: Not to be confused with cochlear implants which
are covered under TRICARE.
5.0 EFFECTIVE
DATE
September 1, 2005.
- END -