130 CMR 426.00 — Audiologist Services

Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title

Table of Contents Page iv

Audiologist Manual Transmittal Letter AUD-17 Date 01/02/15

4. Program Regulations

130 CMR 426.00 Audiologist Services

426.401 Introduction ................................................................................................................. 4-1

426.401: Introduction ................................................................................................................. 4-1

426.402 Definitions ................................................................................................................... 4-1

426.402: Definitions ................................................................................................................... 4-1

426.403 Eligible Members ........................................................................................................ 4-3

426.403: Eligible Members ........................................................................................................ 4-3

426.404 Provider Eligibility ...................................................................................................... 4-3

426.404: Provider Eligibility ...................................................................................................... 4-3

426.405 Out-of -State Services ................................................................................................... 4-4

426.405: Out-of -State Services ................................................................................................... 4-4

426.406 Maximum Allowable Fees .......................................................................................... 4-4

426.406: Maximum Allowable Fees .......................................................................................... 4-4

426.407 Individual Consideration ............................................................................................. 4-4

426.407: Individual Consideration ............................................................................................. 4-4

426.408 Prior Authorization ...................................................................................................... 4-5

426.408: Prior Authorization ...................................................................................................... 4-5

426.409 Separate Procedures .................................................................................................... 4-6

426.409: Separate Procedures .................................................................................................... 4-6

426.410 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services ............... 4-6

426.410: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services ............... 4-6 (130 CMR 426.411 through 426.413 Reserved)

426.414 Dispensing Requirements ............................................................................................ 4-6

426.414: Dispensing Requirements ............................................................................................ 4-6

426.415 Conditions of Payment ................................................................................................ 4-7

426.415: Conditions of Payment ................................................................................................ 4-7

426.416 Reimbursable Services ................................................................................................ 4-7

426.416: Reimbursable Services ................................................................................................ 4-7

426.417 Nonreimbursable Services ........................................................................................... 4-9

426.417: Nonreimbursable Services ........................................................................................... 4-9

426.418 Service Limitations ...................................................................................................... 4-10

426.418: Service Limitations ...................................................................................................... 4-10

426.419 Recordkeeping Requirements ...................................................................................... 4-10

426.419: Recordkeeping Requirements ...................................................................................... 4-10

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426.401 Introduction

426.401: Introduction

130 CMR 426.000 governs services provided by audiologists under MassHealth. An independent audiologist who is licensed and certified in accordance with 130 CMR 426.404 and engages in the practice of audiology is eligible to become a provider in MassHealth. All audiologists participating in MassHealth must comply with MassHealth regulations, including but not limited to those set forth in 130 CMR 426.000 and 450.000: Administrative and Billing Regulations.

426.402 Definitions

426.402: Definitions

The following terms used in 130 CMR 426.000 have the meanings given in 130 CMR 426.402 unless the context clearly requires a different meaning. The reimbursability of services defined in 130 CMR 426.402 is not determined by these definitions, but by application of regulations elsewhere in 130 CMR 426.000 and 450.000: Administrative and Billing Regulations.

Accessories — those essential items or options on a hearing aid, purchased by an audiologist that are not intrinsic components of the basic hearing-aid unit. Accessories do not include nonessential items such as carrying cases.

Adjusted Acquisition Cost — the unit price paid to a manufacturer by an audiologist for a hearing aid or accessories, excluding postal-insurance charges. The adjusted acquisition cost does not exceed the manufacturer's current catalog price and is verified by a copy of the manufacturer's invoice retained by the audiologist in the member's medical record as described under 130 CMR 426.419.

Audiological Services — these services include, but are not limited to, testing related to the determination of hearing loss, evaluation for hearing aids, prescription for hearing-aid devices, and aural rehabilitation.

Auditory Training — the training of the auditory modality to improve understanding of the speech or language of other speakers. Auditory training is one of the components of aural rehabilitation.

Aural Rehabilitation — therapy, including, but not limited to, speech reading and auditory training, provided by a licensed certified audiologist either in a group or individually.

Binaural — the type of fitting or hearing aid necessitated by varying degrees of hearing loss in both ears that requires unparalleled amplification via the use of two microphones and two receivers.

Binaural Fitting — the fitting of two hearing aids, one to each ear, by the audiologist; the fitting to the second ear taking place no later than six months after the fitting to the first ear.

Complete Audiological Evaluation — an evaluation that includes a routine audiological examination (air and bone conduction, spondee thresholds, and word discrimination testing) as recommended by a physician.

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Date of Service — the date on which the medical service is furnished to a member or, in the case of custom-made goods, the date on which the goods are delivered to a member.

Dispense — the prescription of a hearing aid, its modification, its fitting, orientation to its use, and any adjustments required within the manufacturer's trial warranty period.

Dispensing Fee — a one-time-only fee for dispensing monaural or binaural hearing aids. The fee includes initial programming, fitting, orientation to its use, and any adjustments required during the manufacturer’s trial warranty period.

Group Session — therapeutic services directed by the audiologist toward more than one patient in a single encounter, using group participation as a treatment technique.

Hearing Aid — a hearing aid is a small electronic device consisting of a microphone, amplifier and a receiver.

Hearing-Aid Evaluation — a procedure conducted by an audiologist that may include an assessment of the member's response to appropriate tests (real ear measurements or functional gain measurements).

Impedance — an evaluation that includes tympanometry, stapedial acoustic reflex testing, and acoustic reflex decay.

Independent Audiologist — an audiologist who is licensed in accordance with 130 CMR 426.404 and who is engaged in the practice of audiology through a private practice or self-employment, or both.

Major Repair — a repair to a hearing aid that must be made at a repair facility other than the audiologist's place of business.

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Minor Repair — a repair to a hearing aid performed at the audiologist's place of business, such as, but not limited to, the replacement or cleaning of tubing.

Monaural Fitting — the fitting of one hearing aid by an audiologist.

Out-of -Office Visit — treatment provided in a nursing facility or at the member's residence rather than at the audiologist's usual place of business.

Speech Reading — the training of the visual modality to improve the understanding of the speech or language of other speakers. Speech reading is one of the components of aural rehabilitation.

426.403 Eligible Members

426.403: Eligible Members

(A) (1) MassHealth Members. The MassHealth agency covers audiological services only when provided to eligible MassHealth members, subject to the restrictions and limitations described in the MassHealth regulations. MassHealth regulations at 130 CMR 450.105 specifically state, for each MassHealth coverage type, which services are covered and which members are eligible to receive those services. (2) Recipients of the Emergency Aid to the Elderly, Disabled and Children Program. For information on covered services for recipients of the Emergency Aid to the Elderly, Disabled and Children Program, see 130 CMR 450.106.

(B) For information on verifying member eligibility and coverage type, see 130 CMR 450.107.

426.404 Provider Eligibility

426.404: Provider Eligibility

(A) In State. The following requirements apply when the audiology practice is located in Massachusetts. (1) Independent Audiologist. An independent audiologist engaged in private practice in Massachusetts is eligible to participate in MassHealth only if the individual is licensed as an audiologist by the Commonwealth of Massachusetts, Division of Professional Licensure, Board of Registration in Speech-Language Pathology and Audiology. (2) Acute Hospital Outpatient Department, Hospital-Licensed Health Center, or Other Satellite Clinic. An acute hospital’s outpatient department, hospital-licensed health center, or other satellite clinic that participates in MassHealth pursuant to the Executive Office of Health and Human Services (EOHHS) Acute Hospital Request for Applications (RFA) and contract is eligible to provide services designated as hearing aid services in Subchapter 6 of the MassHealth Audiologist Manual for providers under 130 CMR 426.000.

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(B) Out of State. To participate in MassHealth, an independent audiologist practicing outside of Massachusetts must: (1) participate in the Title XIX medical assistance program in the audiologist’s own state; (2) in a state that licenses independent audiologists, be licensed by the appropriate licensing agency in its own state; and (3) possess a Certificate of Clinical Competence in Audiology (CCC-A) issued by the American Speech-Language-Hearing Association (ASHA), if any of the following conditions apply: (a) the audiologist’s own state does not license independent audiologists; (b) the audiologist’s own state does license independent audiologists, but such licensure is not in full compliance with minimum state licensure requirements, specified in 42 CFR 440.110(3); or (c) the audiologist’s own state does license independent audiologists, but such licensure does not, at minimum, meet the academic and clinical requirements of the CCC-A.

426.405 Out-of -State Services

426.405: Out-of -State Services

The MassHealth agency pays out-of -state audiologists in accordance with 130 CMR 450.109.

426.406 Maximum Allowable Fees

426.406: Maximum Allowable Fees

The MassHealth agency pays the lower of the following for audiological services, hearing aids, and related services:

(A) the audiologist's usual and customary fee; or

(B) the maximum fee listed in the applicable fee schedule of the Massachusetts Division of Health Care Finance and Policy.

426.407 Individual Consideration

426.407: Individual Consideration

Services designated "I.C." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual are given individual consideration by the MassHealth agency to determine the amount of payment to be made to the audiologist. The MassHealth agency determines the amount of payment using the following criteria:

(A) the time required to perform the procedure;

(B) the degree of skill required to perform the procedure;

(C) the severity or complexity of the member's hearing disorder or disability;

(D) the policies, procedures, and practices of other third-party purchasers of health care; and

(E) the reasonable and customary practices of audiologists.

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426.408 Prior Authorization

426.408: Prior Authorization

Services designated "P.A." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual require prior authorization from the MassHealth agency.

(A) The MassHealth agency requires prior authorization for (1) any hearing aid that costs more than the amount indicated in the applicable service description in Subchapter 6 of the Audiologist Manual; (2) the replacement of a hearing aid, regardless of the cost of the hearing aid, due to (a) a medical change; (b) loss of the hearing aid; or (c) damage beyond repair to the hearing aid; (3) certain hearing aid related services as specified in Subchapter 6 of the Audiologist Manual; and (4) any replacement of cochlear implant external components.

(B) The MassHealth agency requires the following documents from the provider requesting prior authorization for replacement of hearing aids, or certain hearing aid related services, as applicable: (1) the audiological evaluation required under 130 CMR 426.414(A); (2) the previous audiological evaluation if the replacement hearing aid is needed because of a medical change; (3) a comprehensive report that justifies the medical necessity for the hearing aid; (4) a statement of the circumstances of the loss or destruction of the hearing aid (where applicable); (5) the medical clearance required under 130 CMR 426.414(B); and (6) an itemized estimate of the anticipated cost of the hearing aid.

(C) The MassHealth agency requires the following documents from the provider requesting prior authorization for the replacement of a cochlear implant processor: (1) a comprehensive report that justifies the medical necessity. The report must be within six months prior to the date of service and must include the following: (a) a description and status of the member’s current equipment; (b) do cumentation of the current processor’s obsolescence; (c) member’s current sound field results and speech testing results utilizing the member’s current cochlear implant processor; and (d) invoice stating cost of equipment requested. (2) In the case of loss of a processor, a description of the circumstances regarding the loss, an invoice stating cost of equipment requested, and a list of the member’s current equipment.

(D) All prior-authorization requests must be submitted in accordance with the administrative and billing instructions in Subchapter 5 of the Audiologist Manual. Prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment such as member eligibility or resort to health insurance payment.

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426.409 Separate Procedures

426.409: Separate Procedures

Some procedures are commonly carried out as an integral part of a total service, and as such do not warrant a separate identification. When, however, such a procedure is performed independently of, and is not immediately related to, other services, it is designated as a "separate procedure" or "S.P." in the list of service codes and descriptions in Subchapter 6 of the Audiologist Manual. Thus, when a procedure is performed alone for a specific purpose, it must be considered a separate procedure.

426.410 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services

426.410: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services

The MassHealth agency pays for all medically necessary audiologist services for EPSDT- eligible members in accordance with 130 CMR 450.140: Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services: Introduction, without regard to service limitations described in 130 CMR 426.000, and with prior authorization.

(130 CMR 426.411 through 426.413 Reserved)

426.414 Dispensing Requirements

426.414: Dispensing Requirements

An audiologist may dispense a hearing aid only after receiving the following documentation.

(A) Complete Audiological Evaluation. A complete audiological evaluation includes air and bone conduction, spondee thresholds, and word discrimination testing. (1) The audiologist must have personally completed or received a complete audiological evaluation performed by one of the following: (a) an independent audiologist who personally performed and completed the audiological evaluation; (b) a licensed audiologist who is employed at a speech and hearing clinic and who personally performed and completed the audiological evaluation; or (c) a licensed audiologist who is employed by a physician, or by an acute hospital’s outpatient department, hospital-licensed health center, or other satellite clinic. (2) Audiological evaluations for members under age 18 must be performed by a licensed audiologist pursuant to M.G.L. c. 93 §§ 71 and 72. For members aged 18 or older, the audiological evaluation may also be performed by a licensed hearing instrument specialist. Hearing testing performed by a hearing instrument specialist must meet the requirements of the Massachusetts Rules and Regulations Governing Hearing Instrument Specialists of the Division of Professional Licensure at 265 CMR 2.00 through 10.00. (3) This evaluation must contain the following information: (a) the date of the evaluation; (b) a written summary of findings and impressions, which must include a favorable prognosis for hearing aid use and an assurance that no physiological causes exist that would make the member unable to use a hearing aid; (c) the recommended hearing aid make and model; (d) whether or not the amplification should be monaural (and if so, for which ear) or binaural; and (e) the signature of the audiologist or hearing instrument specialist who performed the evaluation, including the individual’s name and credentials printed clearly and legibly next to the signature. (4) The evaluation must have been performed no more than six months before the dispensing date of the hearing aid.

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(5) The make, model, and specifications such as maximum output, frequency response configuration, and any other special requirements of the hearing aid dispensed must be the same as or comparable to that recommended in the audiological evaluation.

(B) Medical Clearance. The audiologist must have received and must maintain in the member’s medical record pursuant to 130 CMR 426.419(B) a medical clearance from a physician that meets the following conditions: (1) the medical clearance must state that the member is a candidate for and has no medical conditions that would contraindicate the use of a hearing aid; (2) the medical examination by the physician must have been performed no more than six months before the dispensing date of the hearing aid; (3) the medical clearance must be signed by the physician. If the medical clearance is not printed on the physician’s letterhead, the physician’s name and credentials must also be printed clearly and legibly on the medical clearance; and (4) the medical clearance must include the date of the medical clearance, identify which ears are cleared, and indicate whether or not the member, at the time of the medical examination, currently owns or uses a hearing aid for the designated ear.

426.415 Conditions of Payment

426.415: Conditions of Payment

All claims must be submitted in accordance with the administrative and billing instructions in Subchapter 5 of the Audiologist Manual.

426.416 Reimbursable Services

426.416: Reimbursable Services

(A) Complete Audiological Evaluation. (1) Payment for a complete audiological evaluation will be made only if the evaluation is recommended by a physician. (2) Two Audiologists. The MassHealth agency will pay for two audiologists working together to perform an evaluation of an individual member under those circumstances where the knowledge, skills, and experience of the primary audiologist have identified a need for a second audiologist to aid in completing the initial test battery, such as for the testing of very young children or those with other pertinent developmental, physical, cognitive, or maturational factors. Circumstances warranting the services of two audiologists must be fully documented in the member’s medical record. To receive full payment, both audiologists must use the appropriate service code and modifier combination listed in Subchapter 6 of the Audiologist Manual. The MassHealth agency pays one-half of the total reimbursement for two audiologists to each individual provider.

(B) Hearing-Aid Purchase. Payment for a hearing-aid purchase includes the following: (1) the hearing aid and standard accessories and options required for the proper operation of the hearing aid; (2) the proper fitting and instruction in the use, care, and maintenance of the hearing aid; (3) maintenance, minor repair, and servicing of the hearing aid that is furnished free of charge to non-MassHealth patients; (4) the initial manufacturer's warranty against loss or damage; and (5) the loan of a hearing aid to the member by the audiologist, when necessary.

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(C) Earmold. The provider may not claim payment for an earmold until the earmold has actually been delivered to the member. The date of service for the earmold is the date on which the earmold was delivered to the member. An earmold is not reimbursable if it is included in the manufacturer's price of the hearing aid or if the member already has an appropriate earmold. Payment for an earmold includes the following: (1) the ear impression; (2) the proper fitting of the earmold; and (3) any adjustments that may be needed during the operational life of the earmold.

(D) Ear Impression. (1) Ear Impression for an ITE/ITC Hearing Aid. Payment for an ear impression for a hearing aid includes one properly formed ear impression for each in-the-ear (ITE) or in-the-canal (ITC) hearing aid purchased. The provider may not claim payment for an ear impression for a hearing aid until the hearing aid has actually been delivered to the member. (2) Ear Impression for an Earmold for a BTE Hearing Aid. Payment for an ear impression for a hearing aid includes one properly formed ear impression for each behind-the-ear (BTE) hearing aid.

(E) Batteries. Batteries must be new at the time of purchase.

(F) Accessories. Payment for accessories and hearing aid options includes proper fitting and adjustment of the accessory as needed. Accessories must be billed separately from the basic hearing aid unit.

(G) Major Repairs. The provider of a repair service is responsible for the quality of the workmanship and parts, and for ensuring that the repaired hearing aid is in proper working condition. The audiologist is responsible for ensuring that the repaired hearing aid is in proper working condition upon returning the aid to the member. Payment for a major repair to a hearing aid is limited to the following conditions. (1) All warranties and insurance must have expired. (2) The hearing aid must be sent directly to the repair facility or manufacturer that will perform the repair. (The handling charges of an intermediary are not reimbursable.) (3) The repair service must include a written warranty against all defects for a minimum of six months. (4) A copy of the invoice from the repair facility or manufacturer for the cost of the repair must be kept in the member’s medical record.

(H) Office Visits for Evaluation and Management Services. The MassHealth agency pays for an office visit for evaluation and management services only when one or more of the following services is required and is provided as part of the visit: (1) minor adjustments to the hearing aid to ensure a proper fitting, such as an earmold adjustment, when the provider is not the provider who initially fit the hearing aid, and the provider who initially fit the hearing aid is no longer a MassHealth provider; (2) minor office repairs for which the provider customarily charges non-MassHealth members; (3) cleaning of the hearing aid; or (4) replacement of parts such as, but not limited to, tubing, hooks, battery doors, and recasing.

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(I) Refitting Services and Other Professional Services. The MassHealth agency pays for additional fitting or refitting services only where the hearing aid was dispensed more than one year prior to the date of service of the refitting services. These professional services include refitting of the aid, orientation, counseling with the member or member’s family, contact with interpreters, fitting of a loaner aid, and similar services. Payment for these services must include a face-to-face encounter with the member.

(J) Cochlear Implant Service Contract. The MassHealth agency pays for the following cochlear implant services: (1) A service or maintenance contract from the manufacturer of cochlear implant external component that is approved by the U.S. Department of Health and Human Services Food and Drug Administration (FDA), which covers certain costs for repair and replacement parts for an eligible member’s existing cochlear implant external component and is subject to the provisions of 130 CMR 426.416(J)(2) below. (2) The following restrictions apply to the service contract: (a) The service contract must be for a minimum period of one year, paid in full with the enrollment. The MassHealth agency does not pay for a service contract purchased under an installment payment plan, where payment in full at enrollment is also an option. (b) The service contract, when available as a combined option, must include repair and replacement coverage for both the headpiece, controller, and processor. (c) The service contract is not covered until the manufacturer’s original warranty, which is obtained at the time of initial implantation, expires. (d) A copy of the invoice from the manufacturer for the cost of the service contract must accompany the claim form. (e) The service contract must be between the manufacturer and the MassHealth participating provider supplying cochlear implant external services. (K) Replacement and Repair of Cochlear Implant External Components. (1) Replacement of cochlear implant processor requires prior authorization in accordance with 130 CMR 426.408. Replacement of a cochlear implant processor is covered, only when: (a) the existing processor is obsolete; that is, the manufacturer no longer supports repairs on the existing processor; or (b) the existing processor is lost. A lost cochlear implant processor will be replaced by the same make/model as the lost processor, unless the processor is obsolete, in which case it would be substituted by the replacement model; and (c) the existing processor is beyond repair.

(2) Replacement of cochlear implant external components, other than the cochlear implant external processor, are covered only when: (a) the existing component is lost. A lost cochlear implant component will be replaced by the same make/mode as the lost component. (b) the existing processor is beyond repair. (3) MassHealth covers repairs of cochlear implant external components. (4) The replacement or repair services must be performed in a cochlear implant clinic.

426.417 Nonreimbursable Services

426.417: Nonreimbursable Services

The MassHealth agency does not pay for any of the following services:

(A) the rental of hearing aids;

Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 4. P rogram Regulations (130 CMR 426.000) Page 4- 10 Audiologist Manual Transmittal Letter AUD-17 Date 01/02/15 (B ) hearing aids that are completely in the ear canal (CIC); ( C) personal FM systems; or (D) assistive technology devices provided under 34 CFR 300.308, where such devices are maintained at the school facility for the general use of disabled students, and assistive technology services provided under 34 CFR 300.308 relating to the use of such devices.

426.418 Service Limitations

426.418: Service Limitations (A ) The MassHealth agency does not pay for more than one hearing aid per ear per member in a 60-month period without prior authorization in accordance with 130 CMR 426.408. One hearing aid per ear consists of either one binaural hearing-aid fitting, or two monaural hearing aids dispensed more than six months apart, with one dispensed for the left ear and the other dispensed for the right ear. (B ) Two monaural fittings dispensed within a six-month period, with one aid dispensed for the left ear and the other for the right ear, are defined as a single binaural fitting. The MassHealth agency does not pay two monaural dispensing fees for this service. MassHealth pays only one binaural dispensing fee for this service.

426.419 Recordkeeping Requirements

426.419: Recordkeeping Requirements An aud iologist must maintain a medical record for each member for a period of at least as long as the minimum period required by 130 CMR 450.205(G). The MassHealth agency does not pay a provid er for services if the provider does not have adequate documentation to substantiate the provision of services payable under MassHealth. The medical record must contain all pertinent information about the services provided, including the date of service and the dates on which materials were ordered and dispensed. In no in stance does the completion of the appropriate MassHealth claim form, the maintenance of a copy of such a claim, or the simple notation of service codes constitute sufficient documentation for the purposes of 130 CMR 426.419. The recordkeeping requirements are specific to each type of service and are described as follows. (A) Cochlear Implant External Components. The audiologist must maintain the following information in the member's medical record: (1) A history of the member's hearing loss and use of the cochlear implant. The history must contain the following information: (a) the make, model number, type, and date of purchase of the cochlear implant external components; (b) a description of any speech and hearing therapy received by the member; and (c) a description of any medical condition that the member has that may impair vision or affect cochlear implant use. (2) The manufacturer's invoice indicating the actual acquisition cost of the cochlear implant external components, including all discounts, and the warranty indicating the terms of repair or replacement in the event of loss of or damage to the cochlear implant external components. (B) Earmolds. The audiologist must maintain the manufacturer's invoice in the member’s medical record, indicating the actual acquisition cost for the earmold.

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(C) Hearing Aids. The audiologist must maintain the following information in the member's medical record: (1) a history of the member's hearing loss and use of hearing aids. The history must contain the following information: (a) the etiology and chronology of the member's hearing loss, including the member's age at the onset of the loss and an indication of whether the hearing loss is progressive; (b) the make, model number, type, and date of purchase of each hearing aid previously worn by the member; (c) a description of any speech and hearing therapy received by the member; and (d) a description of any medical condition that the member has that may impair vision or affect hearing-aid use; (2) all audiological evaluations. The evaluations must have been performed no more than six months before the dispensing date of the hearing aid; (3) the medical clearance from a physician obtained in accordance with 130 CMR 426.414(B); and (4) the manufacturer's invoice indicating the actual acquisition cost of the hearing aid, including all discounts, and the warranty indicating the terms of repair or replacement in the event of loss of or damage to the hearing aid.

(D) Replacement Hearing Aids. (1) If the member's hearing aid has been lost, the audiologist must maintain in the member's medical record a statement from the member or someone acting on the member's behalf (for example, an immediate family member or other legal representative) that describes the circumstances of the loss of the hearing aid. (2) If the member's hearing aid has been irreparably damaged, the audiologist must maintain in the member's medical record a statement from the manufacturer documenting that the hearing aid cannot be repaired.

(E) Accessories/Options. The audiologist must maintain in the member's medical record the manufacturer's invoice indicating the actual acquisition cost of all accessories/options.

(F) Audiological Evaluation. The results of all audiological evaluations must be fully documented in the member’s medical record.

(G) Office Visits for Evaluation and Management Services. The audiologist must maintain in the member's medical record documentation substantiating the necessity of the office visit and detailing the services provided.

(H) Refitting Services and Other Professional Services. The audiologist must maintain in the member's medical record documentation substantiating the necessity of the office visit and detailing the services provided.

REGULATORY AUTHORITY

130 CMR 426.000: M.G.L. c. 118E, §§ 7 and 12.

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