CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Federal Employee Program and Postal Hearing Aid Prior Approval Request Form

Instructions and requirements for submitting prior approval requests for hearing aid devices and replacement devices for Federal Employee Program (FEP) and Postal members handled by BlueCross BlueShield of Tennessee.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyFederal Employee Program and Postal Hearing Aid Prior Approval Request Form

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionComplete and submit the FEP and Postal Hearing Aid Prior Approval Request Form with required documentation; allow up to 15 days for determination.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

15 daysdetermination time

6 monthssubmission window / approval validity

26 dBnew hearing aid threshold

15 dBreplacement threshold

Prior Approval Coverage Criteria

Prior approval documentation criteria

Criteria and required documentation for new and replacement hearing aid prior approval requests:

All requests must include a copy of the prescription/order for hearing aids.

Include any records documenting the decibel loss if not included on the prescription/order.

New hearing aid requests

Comprehensive audiometric testing or other age-appropriate testing including date, type of testing, and results that demonstrate greater than 26 dB hearing loss (HL).
The name of the hearing aid being considered for purchase.

Replacement hearing aid requests

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyFederal Employee Program and Postal Hearing Aid Prior Approval Request Form

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionComplete and submit the FEP and Postal Hearing Aid Prior Approval Request Form with required documentation; allow up to 15 days for determination.

SourceLink

On This Page

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Provider Submission Requirements and Timelines

Prior Authorization

Prior Approval Required

Complete and submit the Federal Employee Program (FEP)/Postal Hearing Aid Prior Approval Request Form when requesting prior approval for hearing aid devices or services. Prior Approval is required when Medicare or other insurance is primary. Failure to obtain required authorizations may result in denial of benefits. Allow up to 15 days for a determination.

Return methods: mail to BlueCross BlueShield of Tennessee Predetermination/ODM, 1 Cameron Hill Circle, STE 0014, Chattanooga, TN 37402-0014; fax to (423) 591-9091; or submit via MyBlue at fepblue.org.
Contact for questions: FEP Customer Service 1-800-572-1003 or Postal Customer Service 1-866-780-7742, Mon–Fri, 8 a.m.–6 p.m. ET.

Note

Submission Timeframe and Return Methods

Submit the prior approval request within 6 months of the prescriber’s prescription/order. Any approval will be valid for 6 months from the date of the prescription/order.

Date of prescription/order is the operative date for submission timeframe and approval validity.
Allow up to 15 days for a determination; final reimbursement depends on member eligibility, medical necessity, and plan terms.

Documentation Required

Documentation Requirements

Provide complete supporting documentation with the prior approval request. Incomplete documentation may delay review or result in denial.

Required for new hearing aid requests: copy of prescription/order; records documenting decibel loss if not on the prescription; comprehensive audiometric or age-appropriate testing (date, type, results) demonstrating >26 dB hearing loss (HL); name of the hearing aid proposed.
Required for replacement hearing aid requests: copy of prescription/order; records documenting decibel loss if not on the prescription; name or recommendation for replacement device; member’s hearing aid usage history; pertinent medical history and functional status; comprehensive audiometric testing (date, type, results) demonstrating need for replacement; documentation of significant change in hearing (≥15 dB change in at least one frequency between 500 and 4000 Hz).
Include number of pages attached, contact name, phone and fax on the form when returning.
Return completed form by mail, fax, or via MyBlue; final reimbursement determinations consider eligibility, medical necessity criteria, member cost-share, exclusions/limitations, and authorization/referral requirements.

Key Definitions

Prior Approval — definition and validity

DefinitionPrior Approval: Authorization required before purchase or provision of hearing aid devices or services; required when Medicare or other insurance is primary

Submission timingPrior approval must be submitted within 6 months of the prescription/order

Validity periodAny approval will be valid for 6 months from the date of the prescription/order

Comprehensive audiometric testing — definition and required elements

DefinitionComprehensive audiometric testing: age-appropriate hearing tests including date, type of testing, and results

Required elementsTesting must include the date, the type of testing performed, and the test results

Purpose and thresholdsFor new devices, results must demonstrate greater than 26 dB HL; for replacements, testing must demonstrate the hearing loss and need for replacement

OpenPayer

Federal Employee Program and Postal Hearing Aid Prior Approval Request Form

Prior Approval Coverage Criteria

Coding and Thresholds

Provider Submission Requirements and Timelines

Key Definitions