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EHDI: Early Hearing Detection & Intervention | NTRC: National Technical Resource Center

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Last Modified: 04/15/2022

Financing & Reimbursements

Financing

Financing needed for hearing devices is often a challenge for families of children who are deaf or hard of hearing. Public and private insurance programs and nonprofit organizations can help meet these needs. The following resources provide specific contact information for accessing financial assistance:

Reimbursement

a nurse testing a newborn baby's hearing

Reimbursement pertains to how payment is obtained for the provision of medical services. In regards to Early Hearing Detection and Intervention (EHDI), we are talking about the hearing health services provided to infants and young children (screening and diagnostic hearing). Payment for these and other medical charges occur one of 4 ways:

  1. Public Insurance Programs. For those that qualify, these programs are Medicaid, Medicare (age 65 or more) and Children’s Health Insurance Programs (CHIP).
  2. Private Insurance. These programs include employer provided medical insurance programs and privately purchased insurance programs.
  3. Financial assistance programs provided by the medical provider such as a hospital. These programs are for those that are unable to obtain insurance through their employment, can afford to privately purchase insurance and do not qualify for public program. With Medicaid expansion this group has decreased as more people should qualify for Medicaid. Financial assistance programs usually require some sort of co-payment or other contribution to the medical bill.

All reimbursement programs pay for covered medical services based on 3 things:

  1. The medical diagnosis for the patient’s condition
  2. The procedures performed or used to diagnose or treat the patient
  3. The allowed and negotiated rates for those procedures

This section will further describe each of these three elements.

Medical Diagnosis

All health or medical conditions are classified with descriptive “codes” or numbers for billing. Each “code” or number corresponds to an internationally recognized health condition or diagnosis. The coding system used world wide is the International Classification of Diseases, Tenth Revision, Clinical Modification or ICD-10-CM. This system is used by physicians and other healthcare providers to classify and code all diagnosis and symptoms recorded in conjunction with the care provided. The coding system provides a level of detail that is necessary for diagnostic specificity and morbidity and providers should code to the highest level of specificity possible. This coding system is periodically updated with preparation for the next version (ICD-11) being planned for future implementation in the United States.

In regards to EHDI, hearing is screened, evaluated and the result ( normal hearing or hearing loss and type) is matched with the code that most closely describes and matches the results. For example a hearing loss will be coded with the most specific code possible. Coding should e specific to each ear if there is a difference.

Example:
Diagnosis: Code:
Hearing loss (unspecified sensorineural hearing loss) H90.5
Conductive hearing loss, bilateral (both ears) H90.1
Sensorineural hearing loss, bilateral (both ears) H90.3
Mixed hearing loss (conductive and sensorineural) H90.6

Procedures Performed

All of the procedures or “tests” used to determine and describe a health or medical condition must also be described with a code. In this case the coding set is called “Current Procedural Terminology” or more commonly known as CPT codes. CPT codes are a set of medical codes used by physicians, allied health professionals, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform.

Specifically, CPT codes are used to report these procedures and services to federal and private payers for reimbursement of rendered healthcare.

In regards to EHDI, the tests used to screen, diagnose and treat hearing related disorders are matched with a code that most closely describes the screening or diagnostic test(s) used. For example the actual act of screening or diagnosing hearing is matched with a specific code for the screening or diagnostic tests used.

Example:
Test or Procedure: Code:
OAE Screening (automated) 93558
AABR Screening (automated) 92650
Diagnostic OAE 92558
Diagnostic ABR 92652
Audiometry – Visual Reinforcement 92576
Audiometry – Conditioned Play 92582

Allowed and Negotiated Rates

Medicaid and Medicare have determined schedules of diagnosis and procedures they will cover or pay for. They also have determined set rates of payment or amounts they will pay. Most private insurers follow the Center for Medicaid/Medicare Services (CMS) lead in what they will pay for or cover in their insurance policies.

Amounts of payment or reimbursement varies depending on the program, policy with variation between states. In the case of newborn screening, the procedure and its charges may be bundled into the entire delivery charge which would have been negotiated to include all services provided during a delivery stay.

Coding Resources

For detailed and specific information on codes and coding for hearing and hearing related disorders, please see the following resources and links: