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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