ModifiedAlaska MedicaidPolicy N/A
Alaska Medical Assistance: State Fiscal Year 2027 Fee Schedule
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State fiscal year 2027 fee schedule listing procedure codes, required modifiers, medical justification/service authorization requirements, rates, and billing notes for covered services under Alaska Medicaid.
Policy Summary
PayerAlaska Medicaid
PolicyState Fiscal Year 2027 Fee Schedule (Alaska Medical Assistance)
Policy CodePolicy N/A
Change TypeFee schedule updatecode additions and billing requirements
Effective DateJul 1, 2026
Next Review DateN/A
Key ActionAttach encounter notes to claims and obtain service authorization where indicated before billing the specified audiology and cochlear implant services.
SourceLink
POLICY UPDATE CHANGES
New CPT codes effective 1/1/2026 replace deleted CPTs 92592/92593 and 92594/92595 for post-fitting follow-up/adjustment services and electroacoustic analysis/verification.
Claim attachments must include encounter notes for certain evaluation codes (e.g., evaluation of auditory function first hour billed at $129.98).
Service authorization required for selected procedures (examples: electroacoustic analysis/service auth required; AEP and evaluation codes flagged as 'service auth required').
Specific fee amounts assigned to audiology and related services (e.g., AEP SCR $37.83; AEP threshold estimate multi-frequency $159.69; 99202 office new 15 min $109.31).
Extensive HCPCS L-series cochlear implant supply rows with 'X' and 'BY REPORT' indicators and a note that providers may dispense 3 months at a time for certain battery supplies.
7/1/2026-6/30/2027fee schedule period
1/1/2026new CPT effective
dozensprocedure lines
$3,000highest rate seen
$0.90lowest rate seen
Coverage, Medical Justification, and Billing Notes
inv-01: Coverage and billing notes for listed codes
Listed procedures include explicit notes about medical justification/service authorization and assigned rates; modifiers are required for some codes.
69200 — Clear outer ear canal; medical justification/service authorization required; modifier required; allowed rate $113.82.
69210 — Remove impacted ear wax, unilateral; medical justification/service authorization required; allowed rate $68.94.
92507 — Treatment of speech, language, voice, communication (individual); rate $118.16; listed with medical justification/service authorization language.
92508 — Treatment of speech, language, voice, communication (group); rate $35.79.
92516 — Facial nerve function test; rate $101.35; service-auth language present.
92517 — VEMP test I&R cervical; rate $105.64.
Billing note: Rates and additional billing notes provided per code; modifiers like TC and -26 are used and shown in table lines.
Policy note: Coverage and rates are subject to change; clerical errors may occur.
inv-02: Allowed rates and billing notes
Rates and billing notes; some codes require medical justification/service authorization.
92544 — Optokinetic nystagmus test: TC $4.43; full rate $26.38; entries indicate 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED'.
92545 — Oscillating tracking test: TC $4.43; full rate $24.77; 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' noted.
92546 — Sinusoidal rotational test: TC $150.75; full rate $173.89; 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' noted.
92547 — Supplemental electrical test: rate $13.89.
92548 — CDP-SOT 6 COND W/I&R: TC $17.90; full rate $70.56; 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' noted for related entries.
92549 — CDP-SOT 6 COND W/I&R MCT&ADT: TC $24.22; full rate $92.95.
92550 — Tympanometry & reflex threshold: rate $33.18.
92551 — Pure tone hearing test (air): rate $16.64.
92552 — Pure tone audiometry (air): rate $50.74.
92553 — Audiometry (air & bone): rate $61.69.
92555 — Speech threshold audiometry: rate $37.27.
92556 — Speech audiometry complete: rate $58.32.
92557 — Comprehensive hearing test: rate $55.17.
inv-03: Audiology reimbursement criteria
Reimbursement rates and billing notes for audiology CPT codes are provided; some codes denote that service authorization is required and modifiers have distinct rates.
inv-04: coverage and billing rules — audiology
Coverage and billing criteria visible in this excerpt include listed allowable rates per code, medical justification/service authorization requirements for several codes, and alternate billing instructions for CPT-deleted items.
92579 — Visual audiometry (VRA); allowed rate $65.81; listed with 'medical justification/service auth required' language.
92582 — Conditioning play audiometry; allowed rate $109.27; listed with 'medical justification/service auth required' language.
92583 — Select picture audiometry; allowed rate $77.27; listed with 'medical justification/service auth required' language.
92584 — Electrocochleography; allowed rate $148.88; listed with 'medical justification/service auth required' language.
92587 — Evoked auditory test, limited: unit $28.97, TC $4.43, total $33.40; technical component and full rates shown.
92588 — Evoked auditory test, complete: unit $45.47, TC $6.11, total $51.58.
Deleted CPT replacements
Billing and coverage note: several entries include 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' — prior authorization expected where indicated.
inv-05: Replacement-billing rules, auth, and rates for audiology services
Billing and coverage notes for CPT-deleted codes and replacement codes
92590 — Deleted from CPT effective 1/1/2026; for hearing aid candidacy evaluation and device selection (monaural) bill V5010; historical rate referenced in table.
92591 — Deleted from CPT effective 1/1/2026; for hearing aid candidacy evaluation and device selection (binaural) bill V5010; historical rate referenced.
92592 — Deleted from CPT effective 1/1/2026; for hearing aid follow-up and adjustment services (monaural) bill 92636.
92593 — Deleted from CPT effective 1/1/2026; for hearing aid follow-up and adjustment services (binaural) bill 92636.
Coverage requirement: several items are marked 'SERVICE AUTH REQUIRED' — obtain prior authorization where the fee schedule indicates.
inv-06: Coverage and billing stance for audiology/speech device services
Codes listed in this section are included in the Alaska Medicaid fee schedule with specified rates; several legacy codes are deleted and providers must bill alternate codes as indicated.
92601 — Cochlear implant follow-up exam (<7 years): allowed rate $233.88; entry shows 'SERVICE AUTH REQUIRED'.
92602 — Reprogram cochlear implant (<7 years): allowed rate $144.68; listed with service-auth language.
92603 — Cochlear implant follow-up exam (7+ years): allowed rate $222.07; listed with service-auth language.
Billing note: Many listed codes include the text 'SERVICE AUTH REQUIRED' alongside rates; providers should obtain prior authorization where indicated and attach documentation as required.
inv-07: Coverage conditions for listed audiology services
Coverage is provided for listed codes when medical justification is present; some codes require prior service authorization and submission of encounter notes.
Medical justification: Many codes list medical justification language and must meet those requirements (see code-level entries such as cochlear implant follow-up and auditory function evaluations).
Service authorization: 'SERVICE AUTH REQUIRED' is indicated for several codes; prior authorization is required where the schedule specifies.
Documentation attachment: Claim attachment must include encounter notes for specified evaluation codes (explicitly stated alongside certain rates).
Billing: Use the specific reimbursement amounts listed per code when billing Alaska Medicaid; follow modifier (TC, -26) and unit guidance shown in the schedule.
Notice: New CPT code effective date and replacements for deleted CPTs are shown (new codes effective 1/1/2026) and affect billing for post-fitting follow-up and electroacoustic analysis entries.
inv-08: coverage_and_billing_notes
Codes covered when billed with appropriate documentation and, where indicated, service authorization.
92626 — Evaluate auditory function (first hour): claim attachment must include encounter notes when billed; rate context shown ($129.98 referenced as claim-attachment-linked).
92641 — Electroacoustic analysis/verification: listed as 'BY REPORT' and requires service authorization/medical justification; replacement for deleted CPTs 92594/92595.
92636 — Hearing device post-fit follow-up (30 minutes): new CPT effective 1/1/2026 replacing 92592/92593; bill monaural or binaural as specified; entries note medical justification/service auth required.
Billing rule: The incremental add-on code 92627 (each additional 15 minutes) reimbursed at $30.94; apply per documented units and attach required encounter notes where indicated.
inv-09: Coverage and billing criteria — audiology and cochlear supplies
Fees, billing notes, and service authorization indications in these chunks indicate covered services with specified rates and occasional 'service auth required' or 'by report' directions.
92650 — AEP screening auditory potential: allowed rate $37.83.
92651 — AEP hearing status determination I&R: allowed rate $117.10.
92652 — AEP threshold estimate multi-frequency I&R: allowed rate $159.69.
92653 — AEP neurodiagnostic I&R: allowed rate $117.58.
Coverage note: New CPTs effective 1/1/2026 replace deleted 92592/92593 and 92594/92595; post-fitting follow-up and electroacoustic analysis entries reference 'BY REPORT' and service-auth requirements.
Supply note: Multiple cochlear-implant L-codes appear with 'X' and 'BY REPORT' and a dispensing note that providers may dispense certain batteries up to 3 months at a time at a $1.00 charge.
Authorization requirement: Some procedures in this section are marked 'SERVICE AUTH REQUIRED' or 'BY REPORT' indicating prior authorization/medical justification and supporting documentation are needed.
inv-10: Hearing device and service coverage nodes
Coverage and payment details for cochlear implants, auditory/osseointegrated devices, hearing aids, batteries, chargers, fittings, repairs, and dispensing fees as listed in the fee schedule excerpt.
Many HCPCS L-series cochlear implant supply and repair codes (L8613–L8624, L7520) are listed with 'X' or 'BY REPORT' indicators; several lines show a common referenced amount of $172.48 or are priced 'BY REPORT'.
Hearing aid fitting/follow-up: a referenced amount ($150.20) is described as including a minimum of three follow-up visits to check functioning of the hearing aid (monaural or binaural).
Hearing-aid dispensing fee: $250.00 (single) and dispensing fee binaural $500.00 are listed and described as covering repair, replacement parts, periodic cleaning, and labor.
Battery dispensing: providers may dispense up to three months at a time for specified battery HCPCS entries; entries show a $1.00 dispensing note alongside 'BY REPORT' supply rows.
Claims for repairs: claim attachment must include detailed repair information for repair services where indicated.
BY REPORT / documentation
- Multiple device and supply lines are marked 'BY REPORT' indicating variable pricing requiring documentation or supplemental reporting.
- HCPCS/V-code coverage: the listed V-codes and L-codes are presented as covered services with specified fees or 'BY REPORT' instructions; follow individual line notes for billing.
inv-11: Hearing aid reimbursement rules
Payment and coverage details for hearing aids and related services in this part of the fee schedule.
Many individual hearing-aid device codes list reimbursement at $1,500.00 for a single device, with some binaural device entries reimbursed up to $3,000.00; several device lines are 'BY REPORT'.
Dispensing fees: standard dispensing fee $250.00 (covers repair, replacement parts, periodic cleaning, and labor); binaural dispensing fee shown as $500.00 in some entries.
Variable pricing: some device lines and many HCPCS entries are marked 'BY REPORT' indicating variable pricing adjudicated per documentation rather than a fixed schedule amount.
inv-12: hearing aid reimbursement and fees
Reimbursement guidance and amounts for hearing aids and related items
inv-13: hearing aid reimbursement criteria
Reimbursement amounts and billing notes for hearing-related items
Dispensing fee (binaural) — $500.00; covers repair, replacement parts, periodic cleaning, and labor (appears in multiple entries).
Ear mold/insert — $50.00 per unit; 'ear mold/insert, dispensing' also $50.00.
Battery for hearing device — $0.90 per battery; maximum 20 per month / 160 per year.
Ear impression — $70.00 per impression.
Repair communication device — $20.00 (listed as V5336).
Shipping reimbursement — service authorization not required for shipping reimbursement as explicitly stated.
Coverage note: many hearing-aid HCPCS/V-code device lines are listed as 'BY REPORT' (price by report) — follow code-level instructions and documentation requirements when billing.
inv-14: Hearing aid coverage and fees
Reimbursement and billing rules for listed hearing-related codes:
V5264 — Ear mold/insert: $50.00 per unit.
V5265 — Ear mold/insert, dispensing: $50.00 per unit.
V5266 — Battery for hearing device: $0.90 per battery; maximum 20 per month / 160 per year.
V5275 — Ear impression: $70.00 per impression.
V5336 — Repair communication device: $20.00; claim attachments with detailed repair information required where applicable.
BY REPORT items
- Service authorization not required for shipping reimbursement; shipping reimbursement entries are shown separately.
Procedure and HCPCS/CPT/HCPCS Code Tables
Selected procedure codes and descriptors present in excerptCPT | mixedCovered
Audiology/vestibular CPT codes in this segmentCPTCovered
| 92544 | OPTOKINETIC NYSTAGMUS TEST |
| 92545 | OSCILLATING TRACKING TEST |
| 92546 | SINUSOIDAL ROTATIONAL TEST |
| 92547 | SUPPLEMENTAL ELECTRICAL TEST |
| 92548 | CDP-SOT 6 COND W/I&R |
| 92549 | CDP-SOT 6 COND W/I&R MCT&ADT |
| 92550 | TYMPANOMETRY & REFLEX THRESH |
| 92551 | PURE TONE HEARING TEST AIR |
| 92552 | PURE TONE AUDIOMETRY AIR |
| 92553 | AUDIOMETRY AIR & BONE |
1–10 of 13
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audiology/hearing procedure codesCPTCovered
| 92576 | Synthetic sentence ID test |
| 92577 | Stenger test speech |
| 92579 | Visual audiometry (VRA) |
| 92582 | Conditioning play audiometry |
| 92583 | Select picture audiometry |
| 92584 | Electrocochleography |
| 92587 | Evoked auditory test, limited |
| 92587 TC | Evoked auditory test, limited — technical component |
| 92588 | Evoked auditory test, complete |
| 92588 TC | Evoked auditory test, complete — technical component |
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audiology/hearing procedure codes (selected)CPTCovered
| 92587 | Evoked auditory test (limited) / hearing-related procedure (listed) |
| 92588 | Evoked auditory test, complete |
| 92590 | Hearing aid evaluation/selection, monaural (historical CPT entry) |
| 92591 | Hearing aid evaluation/selection, binaural (historical CPT entry) |
| 92592 | Hearing aid check, monaural |
| 92593 | Hearing aid check, binaural |
| 92594 | Electroacoustic/hearing-aid test (various descriptions shown) |
additional audiology/hearing codes and replacementsmixedCovered
| 92595 | Electro hearing aid test both |
| 92596 | Ear protector evaluation |
| 92597 | Oral speech device evaluation |
| 92601 | Cochlear implant follow-up exam <7 |
| 92602 | Reprogram cochlear implant <7 |
| 92603 | Cochlear implant follow-up exam 7 and over |
| 92604 | Reprogram cochlear implant 7 and over |
| V5010 | Hearing aid candidacy evaluation/device selection (HCPCS replacement referenced) |
| V5020 | Conformity evaluation services (HCPCS replacement referenced) |
| 92636 | Hearing aid follow-up and adjustment services (replacement billing indicated) |
1–10 of 11
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audiology / speech device procedure codesCPTCovered
| 92593 | HEARING AID CHECK BINAURAL (deleted from CPT effective 1/1/2026) |
| 92594 | ELECTRO HEARING AID TEST ONE (deleted from CPT effective 1/1/2026); replacement: 92641 for electroacoustic analysis/verification (monaural); conformity evaluation services billed V5020 |
| 92595 | ELECTRO HEARING AID TEST BOTH (deleted from CPT effective 1/1/2026); replacement: 92641 for binaural electroacoustic analysis/verification; conformity evaluation services billed V5020 |
| 92596 | EAR PROTECTOR EVALUATION |
| 92597 | ORAL SPEECH DEVICE EVAL |
| 92601 | COCHLEAR IMPLANT FOLLOW-UP EXAM <7 |
| 92602 | REPROGRAM COCHLEAR IMPLANT <7 |
| 92603 | COCHLEAR IMPLANT FOLLOW-UP EXAM 7/> |
| 92604 | REPROGRAM COCHLEAR IMPLANT 7/> |
| 92605 | EXAM FOR NONSPEECH DEVICE RX |
1–10 of 18
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audiology and cochlear implant servicesCPTCovered
| 92602 | Reprogram cochlear implant <7 |
| 92603 | Cochlear implant follow-up exam 7+ |
| 92604 | Reprogram cochlear implant 7+ |
| 92605 | Examination for non-speech device RX |
| 92606 | Non-speech device service |
| 92607 | Examination for speech-device RX (1 hr) |
| 92608 | Examination for speech-device RX, additional |
| 92609 | Use of speech device service |
| 92610 | Evaluate swallowing function |
| 92618 | Examination for non-speech device RX, additional |
1–10 of 19
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audiology_codesCPTCovered
| 92620 | AUDITORY FUNCTION 60 MIN |
| 92621 | AUDITORY FUNCTION + 15 MIN |
| 92625 | TINNITUS ASSESSMENT |
| 92626 | EVAL AUD FUNCTION 1ST HOUR |
| 92627 | EVAL AUD FUNCTION EA ADDL 15 |
| 92630 | AUD REHAB PRE-LING HEAR LOSS |
| 92633 | AUD REHAB POSTLING HEAR LOSS |
| 92636 | HRG DEV POST-FIT FOLLOW-UP 30 MIN |
| 92641 | ELECTROACOUSTIC ANALYSIS/VERIFCTN |
| 92650 | AEP SCR AUDITORY POTENTIAL |
1–10 of 13
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Audiology and related CPT/HCPCSCPTCovered
| 92636 | Hearing device post-fit follow-up 30 minutes (maps to/replaces 92592/92593) |
| 92641 | Electroacoustic analysis/verification (replaces 92594/92595) — by report |
| 92650 | AEP screening auditory potential |
| 92651 | AEP hearing status determination I&R |
| 92652 | AEP threshold estimation multi-frequency I&R |
| 92653 | AEP neurodiagnostic I&R |
| 97533 | Sensory integration |
| 99202 | Office/outpatient new, 15 minutes |
Cochlear implant supplies and repair HCPCS L-codesHCPCSCovered
| L7520 | Repair prosthesis per 15 min / ossicular implant |
| L8613 | Cochlear implant internal/external component |
| L8614 | Cochlear device component (supply) |
| L8615 | Cochlear implant headset replacement |
| L8616 | Cochlear implant microphone replacement |
| L8617 | Cochlear implant trans coil replacement |
| L8618 | Cochlear implant trans cable replacement |
| L8619 | Cochlear implant external processor/controller replacement |
| L8621 | Replacement zinc air battery |
| L8622 | Replacement alkaline battery |
1–10 of 12
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Hearing aid and related V-codesHCPCSCovered
| V5008 | Hearing screening |
| V5010 | Assessment for hearing aid |
| V5011 | Hearing aid fitting/checking |
| V5014 | Hearing aid repair/modifying |
| V5020 | Conformity evaluation |
| V5030 | Body-worn hearing aid air |
| V5040 | Body-worn hearing aid bone |
| V5050 | Hearing aid monaural in ear |
| V5060 | Behind ear hearing aid |
| V5070 | Glasses air conduction |
1–10 of 13
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hearing aid and accessory codesHCPCSCovered
| V5100 | Body-worn bilateral hearing aid / dispensing references |
| V5120 | Body-worn binaural hearing aid |
| V5130 | In-ear binaural hearing aid |
| V5140 | Behind-ear binaural hearing aid |
| V5150 | Glasses binaural hearing aid |
| V5160 | Dispensing fee, binaural |
| V5181 | Hearing aid monaural BTE |
| V5190 | Hearing aid monaural glasses |
| V5211 | Hearing aid binaural ITE/ITE |
| V5212 | Hearing aid binaural ITE/ITC |
1–10 of 17
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hearing aid and accessory HCPCS/V-codesCPTCovered
| V5181 | HEARING AID MONAURAL BTE |
| V5190 | HEARING AID MONAURAL GLASSES |
| V5211 | HEARING AID BINAURAL ITE/ITE |
| V5212 | HEARING AID BINAURAL ITE/ITC |
| V5213 | HEARING AID BINAURAL ITE/BTE |
| V5214 | HEARING AID BINAURAL ITC/ITC |
| V5215 | HEARING AID BINAURAL ITC/BTE |
| V5221 | HEARING AID BINAURAL BTE/BTE |
| V5230 | HEARING AID BINAURAL GLASSES |
| V5264 | EAR MOLD/INSERT |
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hearing aid and accessory HCPCS V-codesHCPCSCovered
| V5214 | HEARING AID BINAURAL ITC/ITC |
| V5215 | HEARING AID BINAURAL ITC/BTE |
| V5221 | HEARING AID BINAURAL BTE/BTE |
| V5230 | HEARING AID BINAURAL GLASSES |
| V5264 | EAR MOLD/INSERT |
| V5265 | EAR MOLD/INSERT, DISP |
| V5266 | BATTERY FOR HEARING DEVICE |
| V5267 | HEARING AID SUP/ACCESS/DEV |
| V5275 | EAR IMPRESSION |
| V5298 | HEARING AID NOC |
1–10 of 12
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Rounding rule — RBRVS-based rates are rounded to nearest cent after adjustments.
Rounding ruleRBRVS-based rates are rounded to the nearest cent following adjustments for multiple units and cutbacks.
ApplicabilityApplies to RBRVS‑based rates in this fee schedule (SFY 2027).
Operational notePublished rates may vary slightly after automated rounding during adjudication.
Example highest rate — $173.89 (illustrative).
Illustrative highest rate shown$173.89 (sample highest single-service rate in this segment).
ContextAmount appears as the highest explicit rate for a sinusoidal rotational test entry in the schedule excerpt.
UseTreat as illustrative — consult full fee schedule for code‑specific rates when billing.
Sample rates shown — examples of explicit dollar rates present in the schedule.
Sample rate — 92551$16.64
Sample rate — 92552$50.74
Sample rate — 92584$148.88
Sample rate — 92587 (unit + TC)$28.97 unit; TC $4.43; total $33.40
CPT deletions effective date — several codes noted as deleted from CPT effective 1/1/2026 with alternate billing instructions.
Effective deletion date1/1/2026 — several CPT codes are marked 'DELETED FROM CPT EFFECTIVE 1/1/2026'.
Billing alternative exampleFor deleted hearing aid candidacy/device selection codes bill HCPCS V5010 or other specified replacement codes.
Affected servicesIncludes hearing aid selection/check and electroacoustic test codes (see replacement guidance in schedule).
CPT deletions effective date — 1/1/2026 (short form).
CPT deletion effective date (short form)1/1/2026
ImplicationProviders must use replacement HCPCS/CPT codes indicated in the schedule for deleted entries.
ReferenceSee lines noting 'DELETED FROM CPT EFFECTIVE 1/1/2026'.
Deleted from CPT effective 2026-01-01 — e.g., 92593/92594/92595 deleted with billing alternatives (92641, V5020).
Example deleted CPTs92593, 92594, 92595 are shown as deleted from CPT effective 1/1/2026.
Replacement billing — electroacoustic analysisBill 92641 for electroacoustic analysis/verification (monaural or binaural) as indicated.
Replacement billing — conformity evaluationConformity evaluation services may be billed using V5020 where noted.
Additional 15-minute unit rate (92627) — $30.94.
Additional 15‑minute unit rate (92627)$30.94 per additional 15‑minute unit.
ContextUsed as incremental add‑on for evaluation of auditory function (92626/92627 series).
Billing noteApply when reporting additional 15‑minute segments as specified in the schedule.
Claim attachment requirement — claim attachment must include encounter notes for specified evaluation codes (noted alongside $129.98 rate).
Claim attachment requirementClaim attachment must include encounter notes when billing specified evaluation codes (e.g., evaluation of auditory function first hour referenced with $129.98).
Codes referencedExamples include 92626 and related evaluation entries where the schedule states 'CLAIM ATTACHMENT MUST INCLUDE ENCOUNTER NOTES.'
Action for providersAttach encounter documentation to support medical necessity and adjudication for these codes.
Dispensing limit for certain batteries — providers may dispense 3 months at a time for certain batteries (note indicates $1.00 charge).
Dispensing limit for certain batteriesProviders may dispense up to 3 months at a time for specified cochlear implant/hearing device batteries (note indicates a $1.00 dispensing charge entry in supply rows).
Related line itemsAppears in L‑code and battery supply rows (L8621–L8625 etc.) with 'PROVIDERS MAY DISPENSE 3 MONTHS AT A TIME.'
Reimbursement noteSupply lines list $1.00 in the context of dispensing/batch supply; check the specific HCPCS line for exact billing instructions.
Battery dispensing limit — providers may dispense 3 months at a time.
Battery dispensing limitProviders may dispense 3 months at a time for specified battery HCPCS entries.
Where statedAppears on cochlear implant battery/accessory lines (L8619, L8621–L8625) in the schedule.
Operational implicationBillers should document dispensing quantity and follow the three‑month dispensing guidance per line item.
Binaural device reimbursement cap — $3,000.00.
Binaural device reimbursement cap$3,000.00 per binaural device (listed for specified binaural hearing aid entries).
Where appliedShown for in‑ear and behind‑ear binaural device line items (e.g., V5130, V5140).
NoteSome binaural lines are 'BY REPORT' — check the specific code line; when $3,000 is shown, that is the cap for that device category.
Single device reimbursement cap (common) — $1,500.00.
Common single‑device reimbursement cap$1,500.00 per single hearing aid device in multiple entries.
ExamplesApplied to monaural in‑ear and behind‑ear device lines (e.g., V5050, V5060) where $1,500 is listed.
VariationSome device entries are 'BY REPORT' — where $1,500 is listed treat as the maximum published reimbursement for single devices.
Per‑device reimbursement cap — $3,000.00 for specified device types.
Per‑device reimbursement cap for specified device types$3,000.00 listed as maximum reimbursement for several binaural device line items.
Codes referencedExamples include V5130 and V5140 which show $3,000.00 for binaural devices.
Billing implicationWhen a per‑device cap is specified, submit supporting documentation if billing 'BY REPORT' items that may exceed standard caps.
Battery maximums — $0.90 per battery; maximum 20 per month / 160 per year.
Battery per‑unit reimbursement$0.90 per battery.
Monthly/annual quantity maximumsMaximum 20 batteries per month and 160 per year.
Related codesApplies to V5266 (Battery for hearing device) and corresponding HCPCS supply lines in the schedule.
Battery quantity limit — maximum of 20 per month / 160 per year (duplicate source areas).
Battery quantity limit (monthly/annual)Maximum of 20 batteries per month and 160 batteries per year.
Per‑unit reimbursement$0.90 each (see V5266).
DocumentationFollow supply line instructions and ensure dispensing quantity is documented in the claim.
Authorization, Documentation, and Billing Requirements
Documentation Required
Service authorization for audiology/speech/vestibular codes
Service authorization / medical justification is indicated for several audiology, speech, and vestibular diagnostic codes; the fee table shows 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' alongside rates for these codes.
Documentation Required
Service authorization / medical justification notes
Multiple procedure code lines explicitly state 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED'—providers must obtain and document the required justification/service authorization when billing these codes.
- Code examples with this notation include 92548 (CDP‑SOT), 92579–92584 (behavioral/evoked testing), and many others listed in the fee schedule.
Prior Authorization
Service authorization required for select audiology codes
Several audiology codes are flagged with 'SERVICE AUTH REQUIRED' in the schedule; obtain prior authorization per that notation before providing and billing those services.
- The fee lines and additional billing notes show 'SERVICE AUTH REQUIRED' next to certain entries—confirm authorization requirement at claim time.
Billing Rule
Technical component / modifier billing (TC/‑26)
Technical-component (TC) and modifier-specific billing is used for some evoked auditory tests; providers must bill the TC or professional (-26) component as indicated on the fee line.
Documentation Required
Service authorization noted on multiple services
Several service lines repeat 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' next to the code and rate; when present, include the required justification and secure service authorization before billing.
Prior Authorization
Service authorization note (hearing services)
Service authorization is required for certain hearing-related services as indicated by 'SERVICE AUTH REQUIRED' in the schedule; follow the authorization process and document approval in the patient record.
- The schedule marks several hearing‑aid related items and electroacoustic tests with 'SERVICE AUTH REQUIRED.'
Prior Authorization
Service authorization and replacement billing guidance
When CPT codes were deleted effective 1/1/2026, the fee schedule lists replacement billing guidance alongside 'SERVICE AUTH REQUIRED'—bill the specified HCPCS/CPT replacements and follow authorization notes.
Prior Authorization
Service authorization required (per-line items)
Individual fee‑schedule line items show 'SERVICE AUTH REQUIRED' for many codes; obtain prior authorization and attach required documentation when billing those per-line services.
- Codes listed with per-line service auth language include cochlear implant and auditory function services (e.g., 92601–92604, 92620–92621).
Documentation Required
Service authorization plus claim attachment (encounter notes)
Some audiology and cochlear implant services require service authorization and a claim attachment that includes encounter notes; attach those encounter notes as specified when submitting the claim.
- Example: 92626 (evaluate auditory function first hour) and related evaluation codes are noted with 'CLAIM ATTACHMENT MUST INCLUDE ENCOUNTER NOTES.'
Documentation Required
Service authorization and claim attachment requirement
Selected audiology procedures (including evaluation codes) require service authorization and claim attachments—encounter notes must be attached to support medical necessity when billing these codes.
- The schedule explicitly states 'CLAIM ATTACHMENT MUST INCLUDE ENCOUNTER NOTES' for certain evaluation entries (e.g., 92626 and other evaluation codes).
Prior Authorization
Service authorization for electroacoustic analysis and AEP
Medical justification and service authorization are required for electroacoustic analysis and some AEP procedures; follow the 'SERVICE AUTH REQUIRED' instruction before billing.
- Electroacoustic analysis/verification (92641) and AEP codes (92650–92653) are noted with medical justification/service authorization language.
Documentation Required
Electroacoustic analysis: service auth = by report
Electroacoustic analysis/verification is listed as 'SERVICE AUTH REQUIRED = BY REPORT'—obtain authorization and be prepared to submit supporting documentation 'by report' as indicated.
- The fee schedule marks 92641 (electroacoustic analysis/verification) as 'BY REPORT' and includes 'SERVICE AUTH REQUIRED = BY REPORT' language.
Prior Authorization
Authorization required for post‑fitting follow‑up (first 30 minutes)
Post‑fitting follow‑up/adjustment services (first 30 minutes) require medical justification/service authorization; bill the new post‑fit CPT (92636) for monaural or binaural services and follow the 'first 30 minutes' billing guidance.
Documentation Required
Claim attachment required for repairs
For repair claims, a claim attachment must include detailed repair information; include the detailed repair documentation with the claim to support reimbursement.
- The schedule instructs 'CLAIM ATTACHMENT MUST INCLUDE DETAILED REPAIR INFORMATION' for repair service billing lines.
Billing Rule
Timed CPT coding guidance for device selection and fitting
Timed CPT codes are designated for hearing aid candidacy/device selection and device fitting services; use the specified timed CPTs when billing those services.
Billing Rule
Applicable HCPCS / V‑codes for hearing aids and services
Use the listed HCPCS/V‑codes for hearing aid devices, conformity evaluation, and dispensing fees as shown in the fee schedule when billing device and accessory services.
Billing Rule
Hearing aid codes and reimbursement notes
Hearing aid HCPCS/V‑codes and dispensing fees are listed with reimbursement notes and amounts; follow the fee schedule amounts and notes (dispensing fee covers repair/replacement/cleaning/labor) when billing.
- Examples: many binaural device codes show reimbursement up to $3,000.00, dispensing fee binaural $500.00, dispensing fee $250.00 covering repair/replacement/cleaning/labor.
Documentation Required
No authorization required for shipping reimbursement
Service authorization is not required for shipping reimbursement; do not obtain prior authorization solely for shipping reimbursement charges.
- The schedule states 'SERVICE AUTHORIZATION NOT REQUIRED FOR SHIPPING REIMBURSEMENT.'
Documentation Required
Authorization not required for certain hearing aid supplies/shipping
Service authorization is not required for the listed hearing aid supplies and certain services (shipping and specified supply lines); those items may be billed without prior authorization per the fee table notes.
Definitions, Notes, and Billing Conventions
RBRVS-based rates definition — Medicare RBRVS‑derived rates rounded to nearest cent following adjustments.
Definition — RBRVS‑based ratesRBRVS‑based rates are Medicare Resource‑Based Relative Value Scale derived rates rounded to the nearest cent following adjustments.
ScopeThis definition applies to how many procedure line rates are calculated/presented in the SFY 2027 fee schedule.
NoteRounding may cause minor variations between published and paid amounts after unit and cutback calculations.
Indicates that a justification and authorization are required to bill the listed procedure.
Service authorization required indicatorEntries labeled 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' indicate that a justification and prior authorization (service auth) are required to bill the listed procedure.
ExamplesAppears on multiple audiology and cochlear lines (e.g., 92626, 92636, electroacoustic analysis entries).
Provider actionObtain prior authorization and include required justification when filing claims for these codes.
Service authorization / medical justification — 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED' label definition.
Label meaning — 'MEDICAL JUSTIFICATION SERVICE AUTH REQUIRED'Denotes that medical justification and service authorization are required before billing the service.
Where usedApplied to vestibular and other diagnostic entries in the fee schedule (text appears alongside listed rates).
ImplicationClaims for these services should include authorization references and clinical justification per payer policy.
TC — technical component modifier (separate rate/line shown for 92587 TC).
TC — technical component modifierTechnical component (TC) is shown separately on line items (example: 92587 TC with its distinct TC rate).
Billing implicationBill TC and professional component separately when the schedule lists separate TC and total rates.
Example rates92587 TC listed at $4.43; 92587 total $33.40 (unit + TC).
SERVICE AUTH REQUIRED — indicates service authorization is required for certain codes as listed.
SERVICE AUTH REQUIRED notation'SERVICE AUTH REQUIRED' indicates that service authorization is required for certain codes as listed in the schedule.
Typical useAppears on audiology, cochlear implant, and electroacoustic analysis entries that require prior review.
Provider checklistConfirm authorization requirements on a per‑code basis before submitting claims to avoid denials.
Deleted CPT code — document marks certain CPT codes as deleted effective 1/1/2026 and instructs providers to bill alternate codes.
Deleted CPT codes indicatorThe schedule marks certain CPT codes as 'DELETED FROM CPT EFFECTIVE 1/1/2026' and directs providers to bill replacement codes.
Replacement guidanceExamples: bill V5010 for hearing aid candidacy/device selection instead of deleted 92590/92591; bill 92636 for follow‑up instead of 92592/92593.
Reference actionFollow the replacement billing instructions in the fee schedule for deleted CPT entries.
TC modifier — technical component (TC) modifier/rate shown separately (e.g., 92587 TC, 92588 TC) with distinct rates listed.
TC modifier presenceTechnical component (TC) modifier and rate are shown separately for certain evoked auditory tests (e.g., 92587 TC, 92588 TC).
Rate examples92587 TC $4.43; 92588 TC $6.11 — separate from full test rates.
Billing noteSubmit TC modifiers when only the technical component is furnished; match modifier usage to the schedule lines.
DELETED FROM CPT — indicates CPT code deletion effective 1/1/2026; replacement billing codes provided.
DELETED FROM CPT indicatorMarks CPT codes deleted effective 1/1/2026; the schedule provides replacement billing codes such as V5010, 92636, and 92641.
Provider instructionUse the specified replacement HCPCS/CPT codes when billing for services formerly described by deleted CPTs.
Example replacements92641 for electroacoustic analysis/verification; V5010 for hearing aid assessment/device selection.
SERVICE AUTH REQUIRED — notation that prior authorization is required for the listed service.
SERVICE AUTH REQUIRED — schedule noteNotation that prior authorization or service authorization is required for the listed service where 'SERVICE AUTH REQUIRED' appears.
ExamplesAppears on cochlear implant follow‑up, auditory function evaluations, and some electroacoustic analysis lines.
Billing implicationObtain authorization per payer rules before delivering services that carry this notation.
92641 — electroacoustic analysis/verification (definition reference).
92641 definitionElectroacoustic analysis/verification — new CPT mapped as replacement for deleted electro hearing aid test codes.
Usage noteSchedule indicates '92641 ELECTROACOUSTIC ANALYSIS/VRFCTN' as replacement billing for deleted 92594/92595 entries.
Documentation92641 entries are noted 'BY REPORT' in places — document results per instructions.
V5020 — conformity evaluation services billing code (definition reference).
V5020 definitionV5020 — conformity evaluation services billing code used where indicated as replacement for deleted electroacoustic test codes.
ContextFee schedule directs billing V5020 for conformity evaluation services when CPT entries were deleted.
Related guidanceSee replacement instructions alongside deleted CPT 92594/92595 lines.
SERVICE AUTH REQUIRED — service authorization required (definition cross‑reference).
SERVICE AUTH REQUIRED (definition)'SERVICE AUTH REQUIRED' indicates that service authorization is required for the listed service and is used throughout the schedule in code‑level notes.
Where it appearsApplied to multiple audiology and cochlear implant related codes (see code entries for specifics).
Provider actionFollow authorization process described by the payer when this label is present.
CLAIM ATTACHMENT — claim attachment must include encounter notes (definition).
CLAIM ATTACHMENT requirement (definition)'CLAIM ATTACHMENT' indicates that encounter notes or other documentation must be attached to the claim for specified procedures.
ExamplesExplicitly stated for auditory evaluation first hour lines and for several AEP/evaluation codes where $129.98 is referenced.
Billing impactClaims submitted without required attachments risk denial or delayed payment; include encounter notes per schedule instructions.
Post‑fitting follow‑up — new CPT effective 1/1/2026 for post‑fitting follow‑up and adjustment services (first 30 minutes); billable monaural or binaural.
Post‑fitting follow‑up code (new) — effective 1/1/2026New CPT for post‑fitting follow‑up/adjustment services (first 30 minutes) — billable monaural or binaural; replaces deleted CPTs 92592/92593.
Billing guidanceSchedule notes 'HRG DEV POST‑FIT FOLLOW‑UP 30 MIN' (92636 referenced) and indicates 'BY REPORT' for some entries — follow code instructions.
Action requiredUse the new CPT effective 1/1/2026 for post‑fit follow‑up services and follow monaural/binaural billing instructions.
Electroacoustic analysis/verification — new CPT code effective 1/1/2026 replacing deleted CPTs 92594/92595.
Electroacoustic analysis/verification (new CPT) — effective 1/1/2026New CPT (92641) effective 1/1/2026 replaces deleted CPTs 92594/92595 for electroacoustic analysis/verification of hearing devices.
Billing noteSchedule indicates electroacoustic analysis/verification is often 'BY REPORT' — provide required documentation when billing.
Replacement examples92641 replaces 92594 (monaural) and 92595 (binaural); conformity evaluation may use V5020 per schedule instructions.
Claim attachment — documentation (encounter notes) required to be attached to the claim for specific auditory evaluation codes as indicated.
Claim attachment — documentation requiredWhere 'CLAIM ATTACHMENT' is shown, documentation such as encounter notes must be attached to the claim for the specified auditory evaluation codes.
ExamplesExplicit requirement appears alongside evaluation entries (e.g., 92626/92627/92652) and for first‑hour evaluation lines referencing $129.98.
ConsequenceAttach required documentation to avoid claim processing delays or denials.
HRG DEV POST‑FIT FOLLOW‑UP 30 MIN — post‑fitting follow‑up and adjustment services (first 30 minutes) — new CPT effective 1/1/2026.
HRG DEV POST‑FIT FOLLOW‑UP 30 MIN (definition)Post‑fitting follow‑up and adjustment services (first 30 minutes) — new CPT effective 1/1/2026 that replaces deleted CPTs 92592/92593; billable monaural or binaural.
Billing instructionSchedule specifies first 30 minutes as the billed unit for the post‑fit follow‑up code; follow 'by report' instructions where indicated.
Provider implicationUse the new CPT for post‑fit follow‑up services starting 1/1/2026 and ensure proper documentation for monaural vs binaural billing.
Electroacoustic analysis/verification — new CPT effective 1/1/2026 replacing deleted CPTs 92594/92595; descriptive note.
Electroacoustic analysis/verification descriptionElectroacoustic analysis and verification of hearing device — new CPT effective 1/1/2026 replacing deleted CPTs 92594/92595; often billed 'BY REPORT'.
Replacement instructionUse 92641 for electroacoustic analysis/verification and attach supporting documentation per schedule notes.
Rate examplesSome AEP/electroacoustic lines show specific example rates (e.g., 92650 $37.83) while electroacoustic analysis is listed 'BY REPORT'.
Timed CPT codes note — timed CPT codes guidance referenced in schedule.
Timed CPT codes noteTimed CPT codes guidance is provided for hearing aid candidacy/device selection and fitting services (use CPT 92628/92629, 92631/92632 for candidacy/device selection; 92634/92635 for device fitting services).
ContextAppears in the hearing aid/device selection and fitting sections of the schedule to guide appropriate timed billing.
Provider actionFollow timed CPT coding guidance when billing multi‑segment evaluation or fitting services.
Claim attachment — detailed repair information must be attached to claims for repair services.
Claim attachment for repairsDetailed repair information must be attached to claims for repair services (schedule states 'CLAIM ATTACHMENT MUST INCLUDE DETAILED REPAIR INFORMATION').
ExamplesApplies to repair prosthesis per 15 minutes and repair communication device (V5336) lines.
Billing implicationProvide repair detail documentation with the claim to meet reimbursement requirements.
Dispensing fee — hearing aid dispensing fee definition.
Dispensing fee — definitionHearing aid dispensing fee covers repair, replacement parts, periodic cleaning, and labor (example: $250.00 listed).
Binaural dispensing feeDispensing fee (binaural) is shown (example: $500.00) and similarly covers repair, parts, cleaning, and labor.
ContextDispensing fees appear across V‑code device lines and apply per the schedule notes.
Conformity evaluation (V5014/V5020) — definition/reference.
Conformity evaluation (V5014/V5020)Conformity evaluation services are billed using V‑codes such as V5020 (conformity evaluation) or V5014 where indicated.
UsageSchedule references conformity evaluation as a replacement or separate service in context with electroacoustic testing.
Billing noteWhen CPT entries are deleted, V‑codes for conformity evaluation are provided as alternatives.
Dispensing fee Binaural — dispensing fee (binaural) definition/reference.
Dispensing fee binaural — definitionDispensing fee (binaural) covers repair, replacement parts, periodic cleaning, and labor and is shown at $500.00 in the schedule.
ApplicationApplied to binaural dispensing entries (V5160 and related V‑codes).
Provider noteUse the binaural dispensing fee when billing for services covering both ears per the fee schedule guidelines.
Ear mold/insert — ear mold/insert unit price definition.
Ear mold/insert unit price$50.00 per ear mold/insert (V5264/V5265).
Where listedAppears multiple times in the hearing aid supply section of the schedule.
Billing noteCharge per unit; follow quantity limits and dispensing guidance in the schedule.
Dispensing fee (binaural) — dispensing fee binaural covers repair, replacement parts, periodic cleaning, and labor.
Dispensing fee (binaural) coverageDispensing fee binaural covers repair, replacement parts, periodic cleaning, and labor as noted in the schedule (e.g., $500.00).
Related codesAppears with V5160 and other binaural device lines across the fee schedule.
Reimbursement guidanceUse the listed dispensing fee when billing for services that include these covered activities.
Battery reimbursement limits — capped at $0.90 each with monthly and annual maximum quantities.
Battery reimbursement limits — per unitBattery reimbursement capped at $0.90 each (V5266).
Quantity limitsMaximum 20 batteries per month and 160 per year.
Applicable codesApplies to V5266 and associated supply HCPCS lines in the schedule.
Shipping reimbursement — shipping reimbursement reference.
Shipping reimbursementShipping reimbursement is listed in the schedule (refer to supply/device lines where $172.48 or 'BY REPORT' appears with shipping reimbursement notes).
Authorization noteService authorization is not required for shipping reimbursement per schedule text.
Provider actionBill shipping separately as allowed and document per schedule instructions.
V5298 / V5299 — hearing aid NOC and miscellaneous hearing services billed as reported.
V5298 / V5299 definitionV5298 (hearing aid NOC) and V5299 (miscellaneous hearing services) are listed as 'X BY REPORT' and billed as reported in the schedule.
Usage guidanceWhen using NOC or miscellaneous hearing service codes, provide documentation and 'by report' justification per the fee schedule.
Reimbursement noteThese entries are handled on a 'BY REPORT' basis — follow documentation requirements for adjudication.
Policy Summary
PayerAlaska Medicaid
PolicyState Fiscal Year 2027 Fee Schedule (Alaska Medical Assistance)
Policy CodePolicy N/A
Change TypeFee schedule updatecode additions and billing requirements
Effective DateJul 1, 2026
Next Review DateN/A
Key ActionAttach encounter notes to claims and obtain service authorization where indicated before billing the specified audiology and cochlear implant services.
SourceLink
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