Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.51 - Audiology Services › Section 10.09.51.05 - Limitations

Current through Register Vol. 51, No. 14, July 12, 2024
A. Covered
				  audiology services, including hearing aids, cochlear implants, and auditory
				  osseointegrated devices are limited to:
(1)
				  Unless the time limitation is waived by the Program, one audiology assessment
				  per year;
(2) The initial coverage
				  of unilateral or bilateral hearing aids, cochlear implants, or auditory
				  osseointegrated devices when the Department's medical necessity criteria have
				  been met;
(3) One replacementof
				  unilateral or bilateral hearing aids :
(a)
				  Every 5 years for participants younger than 21 years old, unless the Program
				  approves more frequent replacement; or
(b) Every 5 years for participants 21 years
				  old or older, unless the Program approves more frequent replacement, but no
				  more than 1 replacement extraneous to the devices'warranty;
(4) Replacement of hearing aids,
				  cochlear implants and auditory osseointegrated device components that have been
				  lost, stolen, or damaged beyond repair, after all warranties have
				  expired;
(5) Repairs and
				  replacements that take place after all warranties have expired;
(6) A maximum of 76 batteries per participant
				  per 12-month period for a unilateral hearing aid or osseointegrated devices, or
				  152 batteries per participant per 12-month period for bilateral hearing aids or
				  osseointegrated devices purchased from the Department not more frequently than
				  every 6 months, and in quantities of 38 or fewer for a unilateral hearing aid,
				  or 76 or fewer for a bilateral hearing aid;
(7) A maximum of 238 disposable batteries for
				  a unilateral cochlear implant per participant per 12-month period or 476
				  disposable batteries per 12-month period for a bilateral cochlear implant
				  purchased not more frequently than every 6 months, and in quantities of 119 or
				  fewer for a unilateral cochlear implant, or 238 or fewer for a bilateral
				  cochlear implant;
(8) Four
				  replacement cochlear implant component rechargeable batteries per 12-month
				  period for bilateral cochlear implants, and a maximum of two replacement
				  rechargeable batter ies for a unilateral cochlear implant per 12-month period;
(9) Two cochlear implant
				  replacement transmitter cables per 12-month period for bilateral cochlear
				  implants, and a maximum of one replacement transmitter cable for a unilateral
				  cochlear implant per 12-month period;
(10) Two cochlear implant replacement headset
				  cables per 12-month period for bilateral cochlear implants, and a maximum of
				  one replacement headset cable for a unilateral cochlear implant per 12-month
				  period;
(11) Two replacement
				  cochlear implant transmitting coils per 12-month period for bilateral cochlear
				  implants, and a maximum of one replacement transmitting coil for a unilateral
				  cochlear implant per 12-month period;
(12) Charges for routine follow - ups and adjustments
				  which occur more than 60 days after the dispensing of a new hearing aid;
				  and
(13) A maximum of two
				  unilateral earmolds or four bilateral earmolds per 12-month period unless a
				  larger number is determined to be medically necessary.