Effective Date: October 14, 2019

Purpose:
This policy provides guidelines for reimbursement of hearing aid batteries.

Scope:
Products included:

• NJ FamilyCare/Medicaid Plan
• Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP)

Definitions:

• HCPCS Code V5266: Battery for use in hearing device

Policy:
In accordance with Medicaid guidelines, hearing aid batteries function from three (3) to twenty two (22) days. Therefore, it would not be expected to use more than 10-12 batteries per hearing aid, per month.

Procedure:
Horizon NJ Health shall deny excess units of V5266 (Hearing aid battery) when billed by any provider within a three (3) month period and the units are greater than seventy two (72).

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

• Benefit Limitations
• The terms of any applicable provider participation agreement;
• Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
• Medical necessity; and
• Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

References:

New Jersey Administrative Code, Section 10, Chapter 64, Hearing Aid Services

American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services