The purpose of this BadgerCare Plus Update is to clarify coverage of hearing services and hearing instruments under the BadgerCare Plus Benchmark Plan. Certain hearing services are covered under the Benchmark Plan; hearing instruments, however, are not covered. This information is effective for dates of service (DOS) on and after the February 1, 2008, implementation of BadgerCare Plus.

Coverage Policies for Hearing Services and Hearing Instruments Under the Benchmark Plan

Hearing Services Covered for Audiologists and Speech and Hearing Clinic Providers

Hearing services covered under the Benchmark Plan are listed in the Attachment of this Update. The codes listed are reimbursable for audiologists and speech and hearing clinic providers. Hearing services provided by hearing instrument specialists are not reimbursable under the Benchmark Plan. Other providers should refer to service-specific BadgerCare Plus publications or maximum allowable fee schedules for more information about covered hearing services.

For those hearing services covered under the Benchmark Plan, policies and procedures are the same as they are under the Standard Plan. Refer to the appropriate publications for more information on covered services and coverage limitations, policies (including prior authorization and reimbursement), and procedures.

Hearing Aids and Hearing Aid Batteries

Hearing aids and batteries for hearing aids are not covered under the Benchmark Plan.

Cochlear Implants and Bone-Anchored Hearing Devices

Cochlear implants and bone-anchored hearing devices are not covered under the Benchmark Plan. This includes the following Healthcare Common Procedure Coding System (HCPCS) procedure codes:

• Cochlear implant surgeries and materials, such as,
  • L8614-L8619.
  • L8621-L8624.
• Bone-anchored hearing device surgeries and materials, such as,
  • L8690-L8691.
  • V5266 and V5298.

This information corrects the information in the December 2007 Update (2007-103), titled "Durable Medical Equipment Under BadgerCare Plus," which states that durable medical equipment (DME) covered under the Benchmark Plan is the same as that covered under the Standard Plan.

Coverage of Procedure Code V5336

Effective for DOS on and after February 1, 2008, HCPCS procedure code V5336 (Repair/modification of augmentative communicative system or device [excludes adaptive hearing aid]) is a covered service under the Benchmark Plan. The December 2007 Update (2007-101), titled "Hearing Services and Hearing Instruments Under BadgerCare Plus," and Update 2007-103 incorrectly list procedure code V5336 as a noncovered service. Procedure code V5336 is subject to the $5.00 copayment established for DME under the Benchmark Plan.

Providers who have charged Benchmark Plan members for this service should refund the member and submit a claim to BadgerCare Plus for reimbursement.

Previously published DME Benchmark Plan policies and procedures apply to procedure code V5336. Procedure code V5336 is subject to DME service limitations established under the Benchmark Plan. Providers can refer to Update 2007‑103 for more information about DME policies and procedures.

Copayments Under the Benchmark Plan

Hearing Services for Audiologists and Speech and Hearing Clinic Providers

Copayment for covered hearing services provided by audiologists and speech and hearing clinic providers is $15.00 per procedure regardless of the number of procedures performed during one visit. If the BadgerCare Plus reimbursement for the hearing service is less than the established copayment, the member must be charged the lesser amount.

Note: Other providers should refer to previously published Updates for information about copayment policies under the Benchmark Plan.

This information corrects the Benchmark Plan copayment section in Update 2007-101.

Exemptions

Providers are reminded that certain members are exempt from copayment requirements under the Benchmark Plan, including the following:

• Pregnant women.
• Members under 18 years of age who are members of a federally recognized tribe.

Information Regarding BadgerCare Plus HMOs

BadgerCare Plus HMOs are required to provide at least the same benefits as those provided under fee-for-service arrangements. For managed care policy, contact the appropriate managed care organization.

Attachment — Hearing Services Covered Under the BadgerCare Plus Benchmark Plan