Audiological Services

Audiological Services and Hearing Screenings School-Based Medicaid Expansion Information

Audiological Service information can be found in the Speech-Language Therapy Guide from the UMASS and MassHealth

*** Important Information: A Licensed Audiologist listed on your district’s Random Moment Time Study (RMTS) can bill for Medically Necessary Speech-Language Pathology Services and must follow all the requirements to bill as a SLP would.

Audiological Services (include hearing screenings) can be given by a Licensed Audiologist or Licensed Hearing Instrument Specialist. Anyone who possess these licensures must be list in the Therapy Services Pool on the RMTS.

  • Description: Use this PowerPoint as your guide for the requirements to complete billing under the Expansion program. Please read the entire presentation and pay extra attention to the following slides:
    • To determine if services provided meet the definition of Medicaid Medical Necessity: Slides 12-18, 29-36, 40
    • What is included in Comprehensive Evaluations: Slide 37-38
    • What is included in Treatment Plans: Slide 39
    • What is included in Service Authorization: Slide 41-44
    • What should be included in the Activity/Procedure Note on Service Documentation: Slide 48
    • ICD-10 Diagnosis Codes: Slide 62-64

Service Authorization and Service Authorization Guide

  • Description: A requirement for “backup” to substantiate Medicaid Medical Necessity includes comprehensive evaluation, treatment plan, and service authorization. Here you will find a copy of the Service Authorization for Audiology (use the generic Service Authorization form). You will also find a guide that includes all the elements of Service Authorization.  ***It is advised that you combine all the elements found on the Service Authorization Guide with your treatment plan for one document. ***Please note all required “backup” should be kept for 7 years in the case of an audit.

 

Service Documentation Paper Billing Form

  • In-District Service Documentation Billing Form
    • Description: The In-District Service Documentation form can be used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Frontline, Aspen, PowerSchool, SNAP, or SimpleNote. Yet, the form can be used as a guide to identify the procedure codes for your specialty. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis.
  • Out-of-District Day & Residential Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document Medicaid Medically Necessity services that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

Hearing Screenings

  • Description: Hearing Screenings performed by a Licensed Audiologist or Licensed Hearing Instrument Specialist meet the Medical Necessity requirement and require no Service Authorization, care plan, and are not subject to the 8-minute rule:

Hearing Screening Documentation Billing Form

  • Description: The In-District Service Documentation form can be used to document hearing screening services that occurred and to submit for paper billing to NEMB. Please note many clinicians will be documenting in another platform such as Aspen, SNAP, SimpleNote, or other software. ***If your district uses the paper Service Documentation forms to submit billing to NEMB please use this form. Once completed send them to your District’s internal Medicaid contact for the forms to be uploaded via the Sharefile to NEMB, minimally on a monthly basis
    • *** Screenings use a procedure code with TR modifier: 92551- TR (In-district hearing screening)
    • *** ICD-10 Codes for Hearing Screening: Z01.10
  • Out-of-District Day & Residential Hearing Screening Service Documentation Billing Forms
    • Description: The Out-Of-District Service Day and Residential Documentation form can be used to document hearing screenings that occurred and to submit for paper billing to NEMB. Please provide these to the Out-of-District schools that your district’s Medicaid eligible students attend. They should be collected from the school at the end of each month and uploaded to the NEMB secure Sharefile, by your district’s internal Medicaid contact.

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