1. A. Covered audiology services, including hearing aids, cochlear implants, and auditory osseointegrated devices are limited to:

   1. (1) Unless the time limitation is waived by the Program, one audiology assessment per year;
   2. (2) The initial coverage of unilateral or bilateral hearing aids, cochlear implants, or auditory osseointegrated devices when the Department’s medical necessity criteria have been met;

   3. (3) One replacement of unilateral or bilateral hearing aids:

      1. (a) Every 5 years for participants younger than 21 years old, unless the Program approves more frequent replacement; or
      2. (b) Every 5 years for participants 21 years old or older, unless the Program approves more frequent replacement, but no more than 1 replacement extraneous to the devices’ warranty;
   4. (4) Replacement of hearing aids, cochlear implants and auditory osseointegrated device components that have been lost, stolen, or damaged beyond repair, after all warranties have expired;
   5. (5) Repairs and replacements that take place after all warranties have expired;
   6. (6) A maximum of 76 batteries per participant per 12-month period for a unilateral hearing aid or osseointegrated devices, or 152 batteries per participant per 12-month period for bilateral hearing aids or osseointegrated devices purchased from the Department not more frequently than every 6 months, and in quantities of 38 or fewer for a unilateral hearing aid, or 76 or fewer for a bilateral hearing aid;
   7. (7) A maximum of 238 disposable batteries for a unilateral cochlear implant per participant per 12-month period or 476 disposable batteries per 12-month period for a bilateral cochlear implant purchased not more frequently than every 6 months, and in quantities of 119 or fewer for a unilateral cochlear implant, or 238 or fewer for a bilateral cochlear implant;
   8. (8) Four replacement cochlear implant component rechargeable batteries per 12-month period for bilateral cochlear implants, and a maximum of two replacement rechargeable batteries for a unilateral cochlear implant per 12-month period;
   9. (9) Two cochlear implant replacement transmitter cables per 12-month period for bilateral cochlear implants, and a maximum of one replacement transmitter cable for a unilateral cochlear implant per 12-month period;
   10. (10) Two cochlear implant replacement headset cables per 12-month period for bilateral cochlear implants, and a maximum of one replacement headset cable for a unilateral cochlear implant per 12-month period;
   11. (11) Two replacement cochlear implant transmitting coils per 12-month period for bilateral cochlear implants, and a maximum of one replacement transmitting coil for a unilateral cochlear implant per 12-month period;
   12. (12) Charges for routine follow-ups and adjustments which occur more than 60 days after the dispensing of a new hearing aid; and
   13. (13) A maximum of two unilateral earmolds or four bilateral earmolds per 12-month period unless a larger number is determined to be medically necessary.

2. B. Services which are not covered are:

   1. (1) Services not medically necessary;
   2. (2) Hearing aids and accessories not medically necessary;
   3. (3) Cochlear implant services and external components not medically necessary;
   4. (4) Cochlear implant services and external components provided less than 90 days after the surgery which are covered through the initial reimbursement;
   5. (5) Spare or backup cochlear implant components;
   6. (6) Spare or back-up auditory osseointegrated device components;
   7. (7) Replacement of hearing aids, equipment, cochlear implant components, and auditory osseointegrated device components if the existing devices are functional, repairable, and appropriately correct or ameliorate the problem or condition;
   8. (8) Spare or backup hearing aids, equipment, or supplies;
   9. (9) Repairs to spare or backup hearing aids, cochlear implants, auditory osseointegrated devices, equipment, or supplies;
   10. (10) Investigational or experimental services or devices, or both;

   11. (11) Replacement of improperly fitted earmold or earmolds unless the:

       1. (a) Replacement service is administered by someone other than the original provider; and
       2. (b) Replacement service has not been claimed before;
   12. (12) Additional professional fees and overhead charges for a new hearing aid when a dispensing fee claim has been made to the Program; and
   13. (13) Loaner hearing aids.

Authority: Health-General Article, §§2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date: August 16, 1993 (20:16 Md. R. 1277)

Chapter revised effective June 21, 2004 (31:12 Md. R. 911)

Regulation .01B amended effective July 18, 2005 (32:14 Md. R. 1275); January 16, 2006 (33:1 Md. R. 36); October 22, 2018 (45:21 Md. R. 973)

Regulation .02A amended effective January 16, 2006 (33:1 Md. R. 36); October 22, 2018 (45:21 Md. R. 973)

Regulation .03 repealed and new Regulation .03 adopted effective October 22, 2018 (45:21 Md. R. 973)

Regulation .04 amended effective April 4, 2011 (38:7 Md. R. 431); October 22, 2018 (45:21 Md. R. 973)

Regulation .04A amended effective January 16, 2006 (33:1 Md. R. 36)

Regulation .05 amended effective July 18, 2005 (32:14 Md. R. 1275); October 22, 2018 (45:21 Md. R. 973)

Regulation .05A amended effective December 27, 2021 (48:26 Md. R. 1111)

Regulation .05B amended effective January 16, 2006 (33:1 Md. R. 36)

Regulation .06 amended effective October 22, 2018 (45:21 Md. R. 973)

Regulation .06A amended effective July 18, 2005 (32:14 Md. R. 1275)

Regulation .06B, C amended effective January 16, 2006 (33:1 Md. R. 36)

Regulation .06B, D amended effective April 4, 2011 (38:7 Md. R. 431)

Regulation .07 amended effective January 16, 2006 (33:1 Md. R. 36); April 4, 2011 (38:7 Md. R. 431); October 22, 2018 (45:21 Md. R. 973)

Regulation .07B amended effective April 21, 2008 (35:8 Md. R. 805); February 27, 2017 (44:4 Md. R. 253)

Regulation .07C, G, K amended effective July 4, 2016 (43:13 Md. R. 712)