Kentucky Medicaid identifies audiology services as Provider Type (70) individual or (709) group. To enroll and bill Kentucky Medicaid, audiology service providers must be:
- Licensed in the state where they practice. In Kentucky, audiologists must contact the Kentucky Board of Speech-Language Pathology and Audiology.
- Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary for whom it provides services.
What are Audiology services?
Eligible services are medically necessary, limited to one complete hearing evaluation per the calendar year and may include a hearing instrument evaluation which includes three follow-up visits:
- Within the six-month period immediately following fitting with a hearing instrument; and
- Related to the proper fit and adjustment of the hearing instrument including one additional follow-up visit at least six months following the fitting of the hearing instrument and related to the proper fit and adjustment of the hearing instrument.
A referral by a physician to an audiologist is required for an audiology service. The department will not cover an audiology service without a referral from a physician
Additional services may be included in the beneficiaries' health care provider demonstrates that an additional hearing instrument evaluation is medically necessary
Audiologists must meet the coverage provisions and requirements set forth in
907 KAR 1:038 in order to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
How do I verify eligibility?
You may verify eligibility by contacting the automated voice response system at (800) 807-1301, using the web-based KYHealth-Net System.
Kentucky Medicaid shall not reimburse for routine screening of an individual or group of individuals for identification of a hearing problem; hearing therapy and lip-read reading instruction except as covered through the six-month adjustment counseling following the fitting of a hearing instrument; a service for which the beneficiary has no obligation to pay and for which no other person has a legal obligation to provide or to make payment; a telephone call.
Reimbursement for physician services is in accordance with the Audiology Fee Schedule. Reimbursement for audiology services is in accordance with 907 KAR 1:039.
When more than one covered procedure is performed in a single operative session, reimbursement for facility services will be 100 percent of the surgical group rate for the primary procedure and 50 percent of the surgical group rate for the secondary procedure.
Duplication of Service
The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.
CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Kentucky Medicaid currently contracts with DXC
to process the Kentucky Medicaid FFS claims. Each MCO processes its own claims.
Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers need to bill Kentucky Medicaid using the correct CPT codes.
Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO in question, if appealing an MCO claim.
Claims must be received within 12 months from the date of service (DOS) or six months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial. Please refer to the MCO in question, if appealing an MCO claim.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drugs (PAD) list - Pharmacy Branch - (502) 564-6890
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457