The Audiology program is identified in Kentucky Medicaid as Provider Type (70) individual or (509) group and may bill Kentucky Medicaid using these provider type numbers. In order for any Hearing Aid Dealer or Hearing Aid Dealer group to provide services to a Medicaid beneficiary, they must be:

• licensed
• enrolled as a Kentucky Medicaid Provider
• enrolled with the Managed Care Organization (MCO) of any beneficiary they wish to treat.

Covered Services

What are Audiology services? In order to receive services from an audiologist, a beneficiary must have a referral from their primary doctor. Evaluations, follow-up visits, and checkups are covered for beneficiaries under age 21.

Audiologist must meet the coverage provisions and requirements set forth in 907 KAR 1:038 in order to provide covered services. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow the regulations and requirements of the MCO for which they participate. All services must be medically necessary.

Non covered services: Kentucky Medicaid will not reimburse for: a routine screening of a beneficiary or beneficiaries for identification of a hearing problem; hearing therapy except as covered through the six month adjustment counseling following the fitting of a hearing instrument; lip reading instructions 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; a service associated with investigational research; or a replacement; of a hearing instrument for the purpose of incorporating a recent improvement or innovation unless the replacement results in appreciable improvement in the beneficiaries hearing ability as determined by an audiologist.

Reimbursement: Reimbursement for hearing aid services is in accordance to the Kentucky Medicaid Hearing Fee Schedule and is defined in 907 KAR 1:039.

Prior Authorizations

Audiology Services requiring prior authorization must contact CareWise.

Claims Submission

Kentucky Medicaid currently contracts with DXC to process Medicaid claims. (Each MCO contracts with their own billing agent.)

Kentucky Medicaid utilizes National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental.

Coding: Kentucky Medicaid uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15) KY Medicaid requires the use of CMS 1500 billing forms. (eff: 02/12)

Claim Appeals: Appeal requests made on denied claims must be submitted to DXC. The request must include the reason of the request along with a hard copy claim.

Timely Filing: Claims must be received within 12 months from the DOS or 6 months from the Medicare pay date which ever is longer, or within 12 months from the last Kentucky Medicaid denial.

Provider Contact Information

If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Provider Enrollment or Revalidation - (877) 838-5085
Prior Authorization - CareWise - (800) 292-2392
KyHealth.net assistance - DXC - (800) 205-4696
Policy Questions -(502) 564 - 6890