Medical Supplies and Equipment
Audiology Benefits and Criteria
Audiology Benefit Categories
- Hearing Aid, Bone Conduction;
- Hearing Aid, Conventional Analog;
- Hearing Aid, CROS/BiCROS;
- Hearing Aid, Programmable Analog; and
- Hearing Aid Services, Fees, Repairs and Supplies.
See the Audiology Benefit List for
a full list of eligible products, prior approval requirements and frequency
limitations.
Prescriber/Provider Requirements
- Audiology benefits must be prescribed by a physician.
- Audiology benefits must be provided by an audiologist or hearing
aid dispenser.
Prior Approval Process
For all audiology benefits, except batteries, a prior approval is required.
The provider must contact the First Nations and Inuit Health Branch (FNIHB)
Regional Office to initiate the prior approval process. For all new or
replacement hearing aids, the Non-Insured Health Benefits
Hearing Aid and Hearing Aid Repair Prior Approval Form (PDF version) is required.
In addition to the form, this documentation is required to support the
request:
- The prescription;
- The most recent audiometric test (preferably 6 months or less);
- Current hearing aid information (in case of a replacement aid); and
- Other supporting medical documentation (as required).
If a prior approval is granted, a PA number will be provided for billing
purposes. Only then should the provider proceed with the fabrication/fitting/dispensing
of the item. If prior approval is not granted the provider will be advised
of the reason.
For repairs, the same process applies. Once the provider has dispensed
or repaired the hearing aid, the Non-Insured Health Benefits
Hearing Aid and Hearing Aid Repair Confirmation Form (PDF version)
must be completed. The signed
form must then be returned to the FNIHB Regional Office and a copy maintained
by the provider for audit purposes.
Exclusions
Exclusions are items that are not listed as benefits under the NIHB
Program and are not available through the exception process. These items
are therefore not considered for coverage under the NIHB Program and
are not subject to the NIHB appeal process. Under the category of audiology
benefits, these include, but are not limited to:
- Items used exclusively for sports, work or education (for example:
FM equipment);
- Items for cosmetic purposes;
- Cochlear implants;
- Assistive listening devices; and
- Assistive speech devices.
Follow-up
Follow-up needs to be undertaken after the fitting of the hearing aids(s).
If required, the trial period may need to be extended.
Repairs
Only the most recently fit or purchased aid per ear qualifies for maintenance,
repairs and batteries. Repairs must:
- Restore the hearing aid to its original physical condition, allowing
for normal wear and tear; and
- Result in the electroacoustic characteristics and any other features
prescribed by the service provider to be matched to the original fitting.
Quantity Limitations
Items that have an annual quantity limitation must be provided and billed
for no more than a three-month period at a time. This applies to items
claimed with or without a prior approval.
Audiology Benefit List
List Terminology
- Item Description:
- Items are listed within general and specific categories (for example:
Audiology), in alphabetical order by category and item.
- Item Code:
- The 8-digit code that must be submitted to First Canadian Health
for billing purposes.
- Prior Approval:
- Identifies by general category, or by item within the category,
whether prior approval must be obtained by the provider before dispensing
the item.
Hearing Aids, Bone Conduction
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
| Bone conduction hearing aid, left |
|
Yes |
As necessary, minimum of 5 years |
| Bone conduction hearing aid, right |
|
Yes |
As necessary, minimum of 5 years |
Hearing Aids, Conventional Analog
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
| Behind the ear hearing aid, left |
|
Yes |
As necessary, minimum of 5 years |
| Behind the ear hearing aid, right |
|
Yes |
As necessary, minimum of 5 years |
| Custom hearing aid, left |
|
Yes |
As necessary, minimum of 5 years |
| Custom hearing aid, right |
|
Yes |
As necessary, minimum of 5 years |
Hearing Aids, Cros/Bicros
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
| CROS (specify better hearing ear) |
|
Yes |
As necessary, minimum of 5 years |
| BICROS (specify better hearing ear) |
|
Yes |
As necessary, minimum of 5 years |
Hearing Aids, Programmable, Analog
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
| Behind the ear hearing aid, left |
|
Yes |
As necessary, minimum of 5 years |
| Behind the ear hearing aid, right |
|
Yes |
As necessary, minimum of 5 years |
| Custom hearing aid, left |
|
Yes |
As necessary, minimum of 5 years |
| Custom hearing aid, right |
|
Yes |
As necessary, minimum of 5 years |
Hearing Aid Service Fees
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
Assessment/Fitting/
Dispensing Fee, left ear |
|
Yes |
As necessary, minimum of 5 years |
Assessment/Fitting/
Dispensing Fee, right ear |
|
Yes |
As necessary, minimum of 5 years |
| Complete Hearing Assessment (performed bilaterally) - physician
prescription - (Complete Hearing Assessment not applicable for clients
in B.C.) |
|
Yes |
5 years |
| Hearing Aid Performance Check/Readjustment ( must be client initiated),
left ear |
|
Yes |
1 per year (At least 1 year following
issue of the hearing aid) |
| Hearing Aid Performance Check/Readjustment ( must be client initiated),
right ear |
|
Yes |
1 per year (At least 1 year following
issue of the hearing aid) |
| Hearing Re-assessment (partial) (performed bilaterally - physician
or client initiated) |
|
Yes |
2 years |
| Hearing Aid Return fee, left |
|
Yes |
|
| Hearing Aid Return fee, right |
|
Yes |
|
| Repairs and/or remake by manufacturer, left aid |
|
Yes |
outside warranty period |
| Repairs and/or remake by manufacturer, right aid |
|
Yes |
outside warranty period |
| Repairs out of office, dispenser service fee, left |
|
Yes |
|
| Repairs out of office dispenser service fee, right ear |
|
Yes |
|
| In office service fee (includes supplies if necessary), left maximum
$20.00 |
|
No |
1 per year |
| In office service fee (includes supplies if necessary), right
maximum $20.00 |
|
No |
1 per year |
| Replacement ear mold & impression fee, left, child |
|
No |
4 per year |
| Replacement ear mold & impression fee, left, adult |
|
No |
1 per 2 years |
| Replacement ear mold & impression fee, right, child |
|
No |
4 per year |
| Replacement ear mold & impression fee, right, adult |
|
No |
1 per 2 years |
Hearing Aid Supplies Outside Manufacturer Price List
Manufacturer Supplies and Costs On Attached List As Per HCCI Agreement;
no coding required.
| Item Description |
Item
Code |
Prior Approval |
Recommended Replacement Guidelines |
| Batteries, left hearing aid |
|
No |
maximum 12 units every 3 months per
aid |
| Batteries, right hearing aid |
|
No |
maximum 12 units every 3 months per
aid |
| Accessories/supplies maximum $50.00 |
|
No |
1 per 2 years |
|
