Hearing Aid Fitting and Dispensing Services Billing Changes for Texas Medicaid and the CSHCN Services Program Effective January 1, 2017

Effective January 1, 2017, hearing aid fitting and dispensing services can be billed using Audiologist; Otorhinolaryngology Ears, Nose, and Throat (ENT); and Eyes, Ears, Nose, and Throat (EENT) Texas Provider Identifiers (TPIs).

TPIs will automatically update for Hearing Aid/Otorhinolaryngology (ENT) and Hearing Aid/Audiology providers enrolled as individuals. They will no longer be required to maintain a separate enrollment for hearing aid fitting and dispensing services.

Hearing Aid/Otorhinolaryngology (ENT) and Hearing Aid/Audiology providers enrolled as facilities will be able to use an existing audiologist, ENT, or EENT TPI and allow the Hearing Aid TPI to lapse. Hearing Aid facility providers without an existing audiologist, ENT, or EENT TPI for their practice location should complete an Existing Enrollment application for an Audiologist or Physician provider type and relevant specialty.

Hearing Aid/Otorhinolaryngology (ENT) and hearing aid/audiologist providers who have re-enrollment applications in progress, which they have not submitted before January 1, 2017, will have their provider type and provider specialty removed and will be required to select a new provider type and specialty.

Providers re-enrolling as an Individual or Performing Provider must select the appropriate provider type and specialty for their license and title. For example, providers with a physician license and the title DO would enroll as Physician (DO) with the specialty Eyes, Ears, Nose and Throat (EENT) (DO). Choosing any other provider type and specialty will result in an error message indicating the provider type and specialty is not valid for the TPI.

Hearing Aid/Otorhinolaryngology (ENT) and Hearing Aid/Audiologist providers re-enrolling as a Facility will not be able to select a valid provider type and specialty. The provider should complete an Existing Enrollment application for an Audiologist or Physician provider type and the relevant specialty.

Note: Physician/Otorhinolaryngology (ENT), Audiologist and Hearing Aid Fitters should review their information in the “Other Services Offered” section of the online provider lookup (OPL) after January 1, 2017, to confirm fitting and dispensing of hearing aids as applicable. If they would like to update their information, they may do so in Provider Management Information System (PIMS).

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.