CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Hearing Aids and Audiology Services coverage and reimbursement

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyHearing Aids and Audiology Services coverage and reimbursement

Policy CodePolicy N/A

Change TypeAdded claim submission guidanceannual template updates

Effective Date

Next Review Date

Key ActionProviders must maintain documentation supporting billed services and submit V5014 repair claims either on paper with invoices or electronically and, if denied for missing documentation, file a reconsideration with the required documentation attached.

SourceLink

POLICY UPDATE CHANGES

Added Claim Submission information for HCPCS V5014 for INTEGRITY for Duals (options for paper or electronic submission and reconsideration with documentation).

Updated coverage requirements and policy template to include new lines of business; updated Member Responsibility and Disclaimer language.

$1,750coverage limit per individual hearing aid, per ear

V5014special repair claim submission guidance added for INTEGRITY for Duals

3lines of business this policy applies to

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Coverage and Medical Necessity Criteria

Coverage criteria summary

Coverage is provided for medically necessary audiology evaluations and hearing aids prescribed by an appropriately licensed physician as defined by the Hearing Aid Mandate and member benefits.

ALL of the following must be met

Service must be medically necessary and supported in the medical record.
Hearing aids must be prescribed by an appropriately licensed physician.
Coverage is limited to the hearing aid device itself under the Hearing Aid Mandate for Commercial members.
Hearing aid device maximum reimbursement = $1,750 per individual hearing aid, per ear
Cost sharing (copays/coinsurance/deductibles) applies for Commercial members per individual plan.

Relevant Procedure and HCPCS Codes

Audiology procedure codesCPTCovered

92590	Hearing aid examination and selection; monaural
92591	Hearing aid examination and selection; binaural
92592	Hearing aid check; monaural
92593	Hearing aid check; binaural
92594	Electroacoustic evaluation for hearing aid; monaural
92595	Electroacoustic evaluation for hearing aid; binaural

HCPCS hearing aid and service codesHCPCSCovered

V5010	Assessment for hearing aid
V5011	Fitting/orientation/checking of hearing aid
V5014	Repair/modification of a hearing aid
V5020	Conformity evaluation
V5030	Hearing aid, monaural, body worn, air conduction
V5040	Hearing aid, monaural, body worn, bone conduction
V5050	Hearing aid, monaural, in the ear
V5060	Hearing aid, monaural, behind the ear
V5070	Glasses, air conduction
V5080	Glasses, bone conduction

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Documentation, Billing & Submission Requirements

Documentation Required

Medical record documentation requirement

Providers must maintain documentation supporting billed services and medical necessity. Neighborhood may request medical records and follows CMS documentation standards.

Billing Rule

Timely claim submission and coding standards

Submit complete claims within contractual timely filing guidelines. Coding must follow CPT, ICD-10-CM, and HCPCS Level II codebooks.

Billing Rule

Hearing aid repair (V5014) submission for INTEGRITY for Duals

Policy Scope and Rationale

Defines coverage, reimbursement, billing, documentation, and repair submission requirements for hearing aids and related audiology services for Neighborhood Health Plan of Rhode Island members across Medicaid (excluding EFP), Commercial, and INTEGRITY for Duals (Fully Integrated D-SNP). Coverage is provided for medically necessary audiology evaluations and related services, including hearing aids prescribed by an appropriately licensed physician. As defined by the Mandate, a hearing aid is any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing.

For Commercial members, coverage under the Hearing Aid Mandate is limited to the hearing aid device with a maximum reimbursement of $1,750 per individual hearing aid, per ear. Providers must verify member eligibility, coverage, and authorization criteria prior to rendering services and comply with CPT, ICD-10-CM, and HCPCS coding standards.

Providers are required to maintain documentation that supports billed services and medical necessity; Neighborhood may request medical records and follows CMS documentation standards. For hearing aid repair claims billed with HCPCS code V5014 for INTEGRITY for Duals, providers must submit supporting documentation (acquisition cost invoice, MSRP, and usual and customary charge) either by attaching documentation to a paper claim or by submitting electronically and, if denied for missing documentation, filing a claim reconsideration with the required documentation. Neighborhood will review submitted invoices and determine reimbursement on an individual consideration basis.

Defined Terms

Definitions

Hearing aidAny nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing (as defined by the Mandate).

Policy Changes and Document History

2026-05-27material change - added claim submission guidanceLatest

Added Claim Submission information for HCPCS V5014 for INTEGRITY for Duals, including two submission options (paper with documentation or electronic with reconsideration) and that Neighborhood will review invoices to determine reimbursement on an individual consideration basis.

2026-01-01annual review

Annual review refreshed coverage requirements and updated the policy template to include new lines of business, and updated Member Responsibility and Disclaimer language.

2024-07-01policy creation

At-a-Glance Policy Metrics

Key policy statistics

Coverage limit per individual hearing aid, per ear$1,750

Special repair claim submission guidance added for INTEGRITY for DualsHCPCS V5014 — submit paper claim with acquisition cost invoice/MSRP/usual & customary charge attached, or submit electronically and if denied for missing documentation file a claim reconsideration with required documentation; Neighborhood will review invoices and determine reimbursement on an individual consideration basis.

Applicable lines of businessMedicaid (excl. EFP), Commercial, INTEGRITY for Duals