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:
1.0 CPT CODE RANGE
92590 - 92595
2.0 HCPCS 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 calendar 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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