N.J. Admin. Code § 10:64-2.1 - Hearing aid program, policies, and procedures

(a) An otologic examination and a hearing aid examination shall be performed prior to prescribing a hearing aid. The physician or advanced practice nurse performing the medical examination of the Medicaid/NJ FamilyCare eligible beneficiary shall determine if an audiological examination is medically necessary for beneficiaries 21 years of age or older. If the physician or advanced practice nurse determines that an audiological examination is medically necessary for beneficiaries 21 years of age or older, the audiological examination shall be completed prior to prescribing a hearing aid. All Medicaid/NJ FamilyCare eligible beneficiaries under 21 years of age shall have an audiological examination completed prior to the prescribing of a hearing aid. If the beneficiary is a patient of a long-term care facility, a nursing facility hearing aid screening shall also be performed, as indicated at (a)3 below. (See Fiscal Agent Billing Supplement, FD-36.)

1. Otologic examinations shall consist of a history and physical examination of the ear, nose and throat with a relevant diagnosis supporting the need for audiologic and hearing aid examination, with such examination signed and dated by the otologist and forwarded to the individual providing the audiological and hearing aid examinations.

2. Audiological examinations performed by an audiologist or otologist shall include the following (data other than that in this section are acceptable for infants and non-verbal children):

i. Pure tone air and bone conduction thresholds;

ii. Speech reception thresholds;

iii. Speech discrimination scores;

iv. Masking when indicated;

v. Most comfortable listening levels (MCL);

vi. Uncomfortable loudness levels or thresholds of discomfort; and

vii. Middle ear measurements and reflex thresholds when indicated.

3. A hearing aid examination performed by an audiologist, otologist or hearing aid dispenser shall include initial hearing aid testing as described in this section, and follow-up as described in 10:64-2.6;

i. Initial testing shall be as follows:

(1) Either in the sound field both with and without amplification (aided and unaided) to indicate benefit and effectiveness of the prescribed amplification; or

(2) With a master hearing aid.

(b) Hearing aid candidacy requirements shall be as follows:

1. Monaural hearing aid candidates shall meet the following conditions related to treatment of a hearing loss:

i. 45dB or worse hearing loss at 2000 Hz in the better ear; or

ii. 40dB or worse average hearing loss at 500, 1000, 2000 and 3000 Hz in the better ear; or

iii. Asymmetrical hearing loss in which there is:

(1) Either 40dB or worse hearing loss at 2000 Hz in the better ear, or a 35dB or worse average hearing loss at 500, 1000, 2000 and 3000 Hz in the better ear; and

(2) 60dB or worse average hearing loss at 500, 1000, 2000 and 3000 Hz in the poorer ear;

2. A CROS/BICROS hearing aid candidate shall have one ear which is too poor to be aided by a hearing aid device; or

3. Binaural hearing aid candidates and candidates with unilateral hearing loss who request coverage of a hearing aid device for their poor ear shall have hearing loss which meets the following conditions:

i. 35dB or worse hearing loss at 2000 Hz in the ear to be aided; or

ii. 30dB or worse average hearing loss at 500, 1000, 2000 and 3000 Hz in the ear to be aided.

Notes

N.J. Admin. Code § 10:64-2.1

Amended by R.2001 d.71, effective 3/5/2001.
See: 32 New Jersey Register 3965(a), 33 New Jersey Register 793(a).
In (a), substituted references to beneficiaries for references to recipients throughout.
Amended by R.2006 d.289, effective 8/21/2006.
See: 38 New Jersey Register 1385(a), 38 New Jersey Register 3304(a).
Rewrote the introductory paragraph of (a); in (a)1, inserted "shall"; in the introductory paragraph of (b), substituted "shall be" for "are"; in (b)1iii(2), substituted a semicolon for a period at the end; rewrote (b)2; and rewrote introductory paragraph of (b)3. Amended by 53 N.J.R. 2222(a), effective 12/20/2021