CurrentAlabama MedicaidPolicy N/A

Hearing Services - General

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This policy governs coverage, clinical prerequisites, provider participation, and billing for audiological evaluations, special audiological tests, and hearing aids under Alabama Medicaid. Services are primarily limited to Medicaid-eligible individuals eligible for treatment under the EPSDT Program and must be furnished by qualified participating providers.

Policy Summary

PayerAlabama Medicaid

PolicyHearing Services - General

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSeptember 14, 2026

Next Review DateN/A

Key ActionFor hearing-aid approval, document a medical examination and a licensed physician's recommendation for a hearing evaluation dated within six months before fitting.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

EPSDTEligibility

1/yearOtologic evaluations

6 monthsRecommendation window

<6 yearsSpecialist exam age

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CurrentAlabama MedicaidPolicy N/A

Hearing Services - General

Customize your policy alerts

Sign up for all Alabama Medicaid policy alerts

Know when Alabama Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerAlabama Medicaid

PolicyHearing Services - General

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSeptember 14, 2026

Next Review DateN/A

Key ActionFor hearing-aid approval, document a medical examination and a licensed physician's recommendation for a hearing evaluation dated within six months before fitting.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

EPSDTEligibility

1/yearOtologic evaluations

6 monthsRecommendation window

<6 yearsSpecialist exam age

Coverage Criteria

General hearing-service eligibility

Audiological function tests and hearing aids are limited to individuals meeting all of the following requirements.

Basic eligibility: Recipient is Medicaid eligible and eligible for treatment under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.

Hearing-aid medical prerequisite: For hearing-aid approval, the recipient undergoes a medical examination and obtains a recommendation for a hearing evaluation from a licensed physician.Recommendation within 6 months of hearing-aid fitting

The examination should, if possible, be performed by a physician specializing in diseases of the ear.

Alternative otologic evaluation pathway: When a physician specializing in diseases of the ear is unavailable or inaccessible, referral may be made to Children's Rehabilitation Service for otological evaluation, medical clearance, and medical approval for the use of earmolds.

Children under six

Before hearing-aid fitting, children under six must meet the following additional requirement.

Young-child specialist examination: The recipient is examined by an otologist or otolaryngologist before the hearing aid is fitted.Age under 6 years

Otologic evaluation coverage

An eligible recipient is authorized one otologic evaluation per calendar year, including one of the following test types.

Permitted otologic evaluation type

Evaluation components: Basic comprehensive audiometry
Evaluation components: Evoked response audiometry
Evaluation components: Conditioning play audiometry

Special audiological function tests

Special audiological function tests are covered as separately reported services when they meet the following condition.

Separate special testing: The test is not included in a comprehensive evaluation and is reported separately using a descriptor from the audiological series of the CPT manual.

Prior authorization is not required.

Only in-state and borderline out-of-state providers within a 30-mile radius of the Alabama state line may participate in Alabama Medicaid, provided they meet applicable enrollment requirements. This rule applies to audiology providers and hearing-aid providers.

An audiologist employed by a physician may not bill Alabama Medicaid for the same services that the physician billed for the same patient on the same date of service.

Provider Requirements and Billing Risks

Documentation Required

Medical Clearance and Timely Recommendation Required

Before a hearing aid is approved or fitted, the recipient must undergo a medical examination and obtain a licensed physician’s recommendation for a hearing evaluation. The recommendation must be dated within six months before the hearing-aid fitting.

Obtain and document the required medical examination.
Ensure the physician’s hearing-evaluation recommendation is timely—within six months of fitting.

Documentation Required

Furnish Physician Evaluation Statements

The examining physician who refers the patient to a hearing-aid dealer must furnish the dealer with the medical evaluation statements and recommendations required by the Alabama Medicaid program.

Provide the hearing-aid dealer with appropriate medical evaluation statements.
Include the physician’s recommendations required for the hearing-aid service.

Policy Background

This policy governs diagnostic hearing evaluations and hearing-aid provision for Medicaid-eligible individuals, particularly recipients eligible for treatment under the EPSDT Program. Coverage includes specified otologic evaluations and special audiological function tests, with medical evaluation and physician input required before hearing-aid fitting. Additional safeguards apply to children younger than 6 years, who must be examined by an otologist or otolaryngologist before a hearing aid is fitted.

Key Definitions

Special audiological function tests

DefinitionServices not included in a comprehensive evaluation.

ReportingReported separately from the comprehensive evaluation.

Descriptor sourceDescriptors from the audiological series of the CPT manual are used.

Medical examination

DefinitionA medical evaluation by a licensed physician for hearing-aid approval.

Preferred evaluatorA physician specializing in diseases of the ear should perform the examination when possible.

Alternative evaluation source

Policy Summary

PayerAlabama Medicaid

PolicyHearing Services - General

Policy CodePolicy N/A

Change TypeNo material change

Effective DateSeptember 14, 2026

Next Review DateN/A

Key ActionFor hearing-aid approval, document a medical examination and a licensed physician's recommendation for a hearing evaluation dated within six months before fitting.

SourceLink

On This Page

Documentation Required

Submit Audiologist Enrollment Documentation

Audiologists seeking Alabama Medicaid participation must be licensed and submit the required enrollment information to Medicaid’s fiscal agent.

Name and address.
Specialty provider type.
Social Security number and tax identification number.
Copy of the current state license.

Unsupported block type: documentation

Denial Risk

EPSDT Eligibility Limits Coverage

Audiological function tests and hearing aids are limited to Medicaid-eligible individuals who are eligible for treatment under the EPSDT Program. Services for recipients outside EPSDT eligibility may be denied.

Confirm the recipient’s Medicaid and EPSDT eligibility before providing or billing hearing-aid services.

Denial Risk

Missing or Untimely Medical Documentation Risks Denial

Approval may be denied when the required medical examination or physician recommendation is absent, incomplete, or untimely. The hearing-evaluation recommendation must be within six months of the hearing-aid fitting.

Document the examination and physician recommendation before approval or fitting.
Do not rely on a recommendation that is more than six months old at the time of fitting.

Documentation Required

Specialist Examination Required for Children Under Six

A child younger than six years of age must be examined by an otologist or otolaryngologist before a hearing aid is fitted.

Obtain and document the required specialist examination before fitting the aid.

Denial Risk

Use Qualified, Enrolled, and Contracted Providers

Only in-state and borderline out-of-state providers within 30 miles of the state line who meet Alabama Medicaid enrollment requirements may participate. Audiologists must be currently licensed and enrolled, and hearing-aid dealers must be properly licensed and contracted with Alabama Medicaid.

Verify the audiologist’s current state license and Medicaid enrollment.
Verify the dealer’s current hearing-aid license and Alabama Medicaid contract.
Confirm applicable in-state or 30-mile borderline out-of-state participation eligibility.

Billing Rule

Do Not Duplicate Same-Day Billing

An audiologist employed by a physician may not file a claim for the same services billed by that physician for the same patient on the same date of service.

Review same-day claims for duplicate billing before submission.
Submit only the claim permitted for the service and billing arrangement.

Billing Rule

Recipient Billing Is Strictly Limited

A provider may bill an Alabama Medicaid recipient only after the recipient has exhausted all allowed Medicaid benefits or when the service rendered is not covered by Medicaid.

Recipient billing is permitted after all applicable Medicaid benefits are exhausted.
Recipient billing is permitted for a non-covered service.
Do not bill the recipient for a covered service while Medicaid benefits remain available.

When an appropriate physician is unavailable or inaccessible, Children's Rehabilitation Service may provide an otological evaluation, medical clearance, and medical approval for the use of earmolds.