Hearing aid repair claims (V5014) reimbursement guidance
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Guidance for audiology providers on submission and reimbursement of hearing aid repair claims billed with procedure code V5014 for Neighborhood INTEGRITY for Duals (HMO D-SNP) members; explains documentation requirements, reconsideration process, and how claims will be adjudicated.
Neighborhood is updating how V5014 hearing aid repair claims are processed to match the State's approach; reimbursements are now on an individual consideration basis and must include documentation.
V5014 Reimbursement Criteria
V5014 reimbursement criteria
Claims for hearing aid repairs billed under code V5014 are reimbursed on an individual consideration basis and require documentation to support reimbursement.
ALL of the following
- Provider's actual acquisition cost (per invoice)
- Manufacturer's Suggested Retail Price (MSRP)
- Provider's usual and customary charge (Charge Master)
Reimbursement determination
- Neighborhood will review submitted documentation and determine reimbursement on an individual consideration basis
Reimbursement may vary by claim and provider because payment is based on documentation submitted.
Submission & reconsideration process
- Submit the claim on paper with supporting documentation attached
Paper submission must include the required documentation.
- Submit the claim electronically and if it denies for missing documentation submit a claim reconsideration with all required documentation attached
For claims previously processed with no payment, submit a claim reconsideration with the required documentation; a corrected claim is not required.
Procedure Code and Documentation Requirements
| V5014 | Hearing aid repair |
Submission Options and Reconsideration Process
Submission options for V5014 claims
For hearing aid repair claims billed with code V5014, providers may either submit the claim on paper with the supporting documentation attached, or submit electronically and, if the claim denies for missing documentation, file a claim reconsideration with the required documentation. When submitting paper claims, attach the provider's acquisition invoice, MSRP, and usual and customary charge to the claim; when submitting electronically, be prepared to attach those same documents to the reconsideration request if the claim denies.
- Paper submission: attach supporting documentation to the paper claim.
- Electronic submission: if denied for missing documentation, submit reconsideration with all required documents attached.
Reconsideration for denied or unpaid V5014 claims
When a claim denies for missing documentation or was previously processed with no payment, submit a claim reconsideration request attaching the required supporting documentation; a corrected claim is not required for claims previously processed with no payment.
- Attach: provider's actual acquisition cost (per invoice).
- Attach: Manufacturer's Suggested Retail Price (MSRP).
- Attach: provider's usual and customary charge (Charge Master).
- For claims processed with no payment due to a State fee schedule of $0.00, submit reconsideration with documentation — do not submit a corrected claim.
Key Terms and Required Documentation
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