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.
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