Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 323.00 - Rates for Hearing Services › Section 323.02 - Definitions

Current through Register 1525, July 5, 2024
As used in
				101 CMR
				323.00, terms have the meanings in
				101
				CMR 323.02.
Accessories
. Those essential items or
				options on a hearing aid purchased by a hearing instrument specialist that are
				not intrinsic components of the basic hearing aid unit. Accessories do not
				include nonessential items such as carrying cases.
Adjusted Acquisition Cost (AAC)
. The
				actual unit price paid to a manufacturer by a hearing aid dispenser for a
				hearing aid or accessories, including costs for shipping and handling, and
				excluding postal insurance charges.
Assessment of Hearing Aid
. A procedure
				that includes
(a) assessment of a
			 patient's performance by appropriate tests with hearing aid devices;
(b) a recheck of the patient and hearing aid
			 after the prescribed aid has been fitted and used for a trial period;
			 and
(c) counseling related to the
			 patient's adjustment to the use of the hearing aid.
Audiological Evaluation
. A routine
				audiological evaluation that includes
(a) pure tone audiogram, by air and bone
			 conduction testing; and
(b) speech
			 reception and discrimination testing.
Aural Rehabilitation
. Therapy provided
				by a qualified audiologist either in a group or individually including, but not
				limited to:
(a)
Lip-reading
. Training of the visual modality to
			 improve the understanding of the speech or language of other
			 speakers.
(b)
Auditory
			 Training
. Training of the auditory modality to improve the
			 understanding of the speech or language of other speakers.
Binaural
. The type of fitting or aid
				necessitated by varying degrees of hearing loss in both ears that requires
				unparalleled amplification
via
the use of two microphones
				and/or receivers.
Binaural Fitting
. The fitting of two
				hearing aids, one to each ear, by a provider; the fitting to the second ear
				taking place no later than six months after the fitting to the first
				ear.
Contralateral Routing Hearing Aid
. A
				type of hearing aid configuration that routes sounds from the hearing-impaired
				ear to the hearing ear
via
the use of a microphone.
Electroacoustic Evaluation for Hearing
				Aid
. A check of the patient's personal hearing aid (includes
				electroacoustical analysis of the aid).
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Governmental Unit
. The Commonwealth,
				any department, agency, board, division, or commission of the Commonwealth, and
				any political subdivision of the Commonwealth.
Hearing Aid
. A small electronic device
				consisting of a microphone, an amplifier, and a receiver.
Hearing Aid Check
. A check of the
				functioning of the patient's monaural or binaural hearing aid.
Hearing Services
. Services including
				testing related to the determination of hearing loss, evaluation of hearing
				aids, the prescription of hearing aid devices, and aural rehabilitation.
Individual Consideration (I.C.)
. A
				designation indicating that there is no specified rate for a given service.
				Payment amounts for services designated "I.C." are determined by the
				governmental unit purchasing such services. The governmental unit determines
				the appropriate payment based on the provider's report of services provided and
				documentation as requested by the governmental unit. The report must include a
				pertinent history and diagnosis, a description of the service rendered, and the
				length of time spent with the patient. In making the determination of the
				appropriate payment amount, the governmental unit uses the following
				criteria:
(a) the policies,
			 procedures, and practices of other third-party purchasers of care, both
			 governmental and private;
(b) the
			 severity and complexity of the patient's disorder or disability;
(c) prevailing provider ethics and accepted
			 practice; and
(d) the time, degree
			 of skill, and cost including equipment cost required to perform the
			 procedure(s).
Industrial Accident Patient
. A person
				who receives medical services for which persons, corporations, or other
				entities are in whole or part liable under M.G.L. c. 152 (the Workers'
				Compensation Act).
Major Repairs
. Repairs to a hearing
				aid that must be made by a repair facility other than the provider's place of
				business.
Minor Repairs
. Repairs performed at
				the provider's place of business such as, but not limited to, replacement and
				cleaning of tubing.
Monaural Fitting
. The fitting of one
				hearing aid by a provider.
Non organic Test Battery
. Tests done
				to determine functional hearing loss.
Out-of-office Rates
. Providers must
				use the appropriate place of service (POS) code when billing for out-of-office
				services. Out-of-office rates are 115% of their respective in-office
				counterparts.
Out-of-office Services
. Authorized
				services provided in a nursing home, school, patient's home, or any other
				setting where the provider travels from his or her usual place of business to
				provide the service. Out-of-office services include only the codes in the
				following sections.
101 CMR
				323.03(5)(b)1.: Hearing Aid
				Dispensing Fees
101 CMR
				323.03(5)(c): Maximum Fee
				for Earmolds
101 CMR
				323.03(5)(d): Maximum Fee
				for Ear Impressions
101 CMR
				323.03(5)(e): Maximum Fee
				for Batteries
101 CMR
				323.03(5)(i): Maximum Fee
				for Minor Repairs
101 CMR
				323.03(5)(j): Maximum Fee
				for Major Repairs
Place of Service (POS)
. Providers who
				file claims with MassHealth must use the following CMS POS codes.
03 - School
04 - Homeless shelter
11 - Office
12 - Home
22 - Outpatient hospital
26 - Military treatment facility
31 - Skilled nursing facility
32 - Nursing facility
99 - Other place of service
Provider
. A provider acting within the
				scope of the provider's license, in accordance with all applicable state and
				federal laws, who meets such conditions of participation as have been adopted
				by governmental units purchasing audiological services or by purchasers under
				M.G.L. c. 152 (the Workers' Compensation Act), and who is one of the
				following:
(a) an audiologist who is
			 currently licensed by the Massachusetts Board of Speech language Pathology and
			 Audiology;
(b) any speech and
			 hearing center (proprietorship, partnership, or corporation) that is not part
			 of a hospital and provides authorized speech, hearing, or language services
			 provided by a licensed, certified audiologist or a certified speech and
			 language pathologist and does not bill separately from such facility for
			 professional services;
(c) an
			 audiology assistant who is currently licensed by the Massachusetts Board of
			 Registration in Speech-language Pathology and Audiology; or
(d) a hearing instrument specialist who is
			 currently licensed by the Massachusetts Board of Registration of Hearing
			 Instrument Specialists.
Publicly aided Individual
. A person
				who receives health care and other services for which a governmental unit is in
				whole or in part liable under a statutory program of public assistance.
Used Hearing Aid
. Any hearing aid that
				has been worn for any period of time by a user.