1. (1) The provider shall bill the Division for hearing aids at the provider’s acquisition cost and shall be reimbursed at that rate. For purposes of this rule, acquisition cost is defined as the actual dollar amount paid by the provider to purchase the item directly from the manufacturer or supplier plus any shipping or postage.
2. (2) The provider shall submit history of hearing aid use and an audiogram when requesting Prior Authorization (PA) for hearing aids.

3. (3) Procedure codes are the following:

   1. (a) 92594 – Electroacoustic evaluation for hearing aid, monaural;
   2. (b) 92595 – Electroacoustic evaluation for hearing aid, binaural;
   3. (c) 92596 – Ear protector eval, measurement of adequacy of hearing protection device;
   4. (d) V5014 – Repair/modification of hearing aid, requires PA;
   5. (e) V5266 – Hearing aid batteries, limited to 60 individual batteries per calendar year;
   6. (f) V5264 – Ear mold/insert, not disposable, any type, requires PA;
   7. (g) V5274 – Assistive listening device, not otherwise specified, requires PA;
   8. (h) V5030 – Hearing aid, monaural, body worn, air conduction, requires PA;
   9. (i) V5040 – Hearing aid, monaural, body worn, bone conduction, requires PA;
   10. (j) V5050 – Hearing aid, monaural, in the ear, requires PA;

   11. (k) V5060 – Hearing aid, monaural, behind the ear, requires PA;

       1. (L) V5130 – Hearing aid, binaural, in the ear, requires PA;
   12. (m) V5140 – Hearing aid, binaural, behind the ear, requires PA;
   13. (n) V5171 – Hearing aid, contralateral routing device, monaural, ITE, requires PA;
   14. (o) V5180 – Hearing aid, contralateral routing device, monaural, BTE, requires PA;
   15. (p) V5211 – Hearing aid, contralateral routing system, binaural, ITE- requires PA;
   16. (q) V5221 – Hearing aid, contralateral routing system, binaural, BTE- requires PA;
   17. (r) V5246 – Hearing aid, digitally programmable analog, monaural, ITE, requires PA;
   18. (s) V5247 – Hearing aid, digitally programmable analog, monaural, (BTE) requires PA;
   19. (t) V5252 – Hearing aid, digital programmable, binaural, ITE, requires PA;
   20. (u) V5253 – Hearing aid, digital programmable, binaural, BTE, requires PA;
   21. (v) V5256 – Hearing aid, digital, monaural, ITE, requires PA;
   22. (w) V5257 – Hearing aid, digital, monaural, BTE, requires PA.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.025 & ORS 414.065

History

DMAP 93-2023, amend filed 12/21/2023, effective 01/01/2024
DMAP 44-2019, amend filed 11/06/2019, effective 11/14/2019
DMAP 102-2018, amend filed 12/13/2018, effective 12/13/2018
DMAP 100-2018, amend filed 11/06/2018, effective 11/06/2018
DMAP 49-2016, f. 7-26-16, cert. ef. 8-1-16
OMAP 18-2006, f. 6-12-06, cert. ef. 7-1-06
OMAP 12-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 1-2003, f. 1-31-03, cert. ef. 2-1-03
OMAP 10-2002, f. & cert. ef. 4-1-02
OMAP 39-2001, f. 9-24-01, cert.e f. 10-1-01
OMAP 20-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 38-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 36-1999, f. & cert. ef. 10-1-99
HR 27-1993, f. & cert. ef. 10-1-93
HR 11-1992, f. & cert. ef. 4-1-92
HR 5-1991, f. 1-18-91, cert. ef. 2-1-91