(1) The following requirements and restrictions apply for purposes of coverage and reimbursement of audiology services under the Montana Medicaid program.
(2) Audiology services are hearing aid evaluations and basic audio assessments provided within the scope of practice permitted by state law to recipients with hearing disorders. Audiology services must be provided by a licensed practitioner within the scope of the practice permitted by state law. The provider's records maintained under ARM 37.85.414 must demonstrate the medical necessity for the service, and compliance with applicable supervision and protocol requirements.
(a) Medicaid coverage and reimbursement for dispensing of hearing aids is available to licensed hearing aid dispensers and audiologists, subject to the requirements of ARM 37.86.801 through 37.86.805 and the requirements generally applicable to Medicaid providers.
(3) Audiology services may be provided to a recipient only upon a current written or verbal order or referral by a physician or mid-level practitioner. All verbal orders or referrals must be followed up by a written order received by the provider within 30 days of the verbal order or referral.
(a) The provider is not entitled to Medicaid reimbursement if services are provided prior to actual receipt of the written or verbal order or referral. Referrals and orders are valid for Medicaid purposes for no more than 90 days.
(b) The provider must maintain the referral or order of the physician or mid-level practitioner and appropriate records that demonstrate compliance with Medicaid requirements. The provider must provide copies of these documents at no charge to the department or its agents upon request.
(4) In addition to the requirements of ARM 37.85.414, a provider must maintain the written orders of the physician or mid-level practitioner and all diagnostic and evaluative reports. The provider must provide copies of these documents at no charge to the department or its agents upon request.
(5) The audiology services must be required as preliminary steps to obtaining a medically necessary hearing aid or device for the recipient.
(6) Basic audio assessments must include for each ear under earphones:
(a) Pure tone air conduction thresholds at the frequencies of .5, 1, 2, 3, and 4 KHZ;
(b) Speech reception threshold; and
(c) Speech discrimination (word recognition) test under phonetically-balanced (PB) max conditions, and either pure tone bone conduction thresholds at the frequencies specified in (6)(a), or tympanometry, including tympanogram, acoustic reflexes, and static compliance.
(7) Medicaid reimbursement for a basic audio assessment or a hearing aid evaluation includes all related supplies and items used in the performance of the assessment or evaluation.