Pricing Modifier. Informational Modifier

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Helena Anderson
8 years ago
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1 1 National Provider of a hearing aid RT, LT, 50 per repair of a hearing aid , 32, 99 RT, LT, 50 per repair of a hearing aid , 32 RT, LT, 50 per repair of a hearing aid , 32 RT, LT, 50 per repair of a hearing aid , 32 RT, LT, 50 per repair binaural each binaural , 32, 99 each binaural , 32 each

of a hearing aid 25 220 31, 32 RT, LT, 50 per repair of a hearing aid 31 220 31, 32 RT, LT,

2 2 National Provider binaural , 32 each binaural , 32 each ear canal) RT, LT, 50 each ear canal) , 32, 99 RT, LT, 50 each ear canal) , 32 RT, LT, 50 each ear canal) , 32 RT, LT, 50 each ear canal) , 32 RT, LT, 50 each

32, 99 RT, LT, 50 each ear canal) 24 220 31, 32 RT, LT, 50 each ear

3 3 National Provider canal) RT, LT, 50 each canal) , 32,99 RT, LT, 50 each canal) , 32 RT, LT, 50 each canal) , 32 RT, LT, 50 each canal) , 32 RT, LT, 50 each binaural, CIC per pair binaural, CIC , 32,99 per pair binaural, CIC , 32 per pair binaural, CIC , 32 per pair

31 220 31, 32 RT, LT, 50 each binaural, CIC 01 220 22 per pair binaural, CIC 20 220 31,

4 4 National Provider binaural, CIC , 32 per pair binaural, ITC per pair binaural, ITC , 32,99 per pair binaural, ITC , 32 per pair binaural, ITC , 32 per pair binaural, ITC , 32 per pair RT, LT, 50 each , 32,99 RT, LT, 50 each , 32 RT, LT, 50 each , 32 RT, LT, 50 each , 32 RT, LT, 50 each

31, 32 per pair binaural, ITC 31 220 31, 32 per pair 01 220 22 RT, LT, 50 each 20 220 31, 32,99

5 5 National Provider monaural, ITC RT, LT, 50 each monaural, ITC , 32,99 RT, LT, 50 each monaural, ITC , 32 RT, LT, 50 each monaural, ITC , 32 RT, LT, 50 monaural, ITC , 32 RT, LT, 50 each monaural, ITE RT, LT, 50 each monaural, ITE , 32,99 RT, LT, 50 each monaural, ITE , 32 RT, LT, 50 each monaural, ITE , 32 RT, LT, 50 each monaural, ITE , 32 RT, LT, 50 each monaural, BTE RT, LT, 50 each each

01 220 22 RT, LT, 50 each monaural, ITE 20 220 31, 32,99 RT, LT, 50 each monaural, ITE 24 220 31, 32 RT, LT, 50 each

6 6 National Provider monaural, BTE , 32,99 RT, LT, 50 each monaural, BTE , 32 RT, LT, 50 each monaural, BTE , 32 RT, LT, 50 each monaural, BTE , 32 RT, LT, 50 each binaural, CIC per pair binaural, CIC , 32,99 per pair binaural, CIC , 32 per pair binaural, CIC , 32 per pair binaural, CIC , 32 per pair binaural, ITC per pair binaural, ITC , 32,99 per pair

per pair binaural, CIC 20 220 31, 32,99 per pair binaural, CIC 24 220 31, 32 per pair binaural, CIC 25 220 31, 32

7 7 National Provider binaural, ITC , 32 per pair binaural, ITC , 32 per pair binaural, ITC , 32 per pair binaural, ITE per pair binaural, ITE , 32,99 per pair binaural, ITE , 32 per pair binaural, ITE , 32 per pair binaural, ITE , 32 per pair binaural, BTE per pair binaural, BTE , 32,99 per pair binaural, BTE , 32 per pair

binaural, ITE 24 220 31, 32 per pair binaural, ITE 25 220 31, 32 per pair binaural, ITE 31 220 31, 32 per

8 8 National Provider binaural, BTE , 32 per pair binaural, BTE , 32 per pair disposable, any type RT, LT, 50 per mold disposable, any type , 32, 99 RT, LT, 50 per mold disposable, any type , 32 RT, LT, 50 per mold disposable, any type , 32 RT, LT, 50 per mold disposable, any type , 32 RT, LT, 50 per mold disposable, any type RT, LT, 50 per mold disposable, any type , 32, 99 RT, LT, 50 per mold disposable, any type , 32 RT, LT, 50 per mold disposable, any type , 32 RT, LT, 50 per mold

32 RT, LT, 50 per mold disposable, any type 31 220 31, 32 RT, LT, 50 per mold disposable, any type 01 220 22 RT, LT, 50 per mold 32 RT, LT, 50

9 9 National Provider disposable, any type , 32 RT, LT, 50 per mold hearing device per battery hearing device , 32,99 per battery hearing device , 32 per battery hearing device hearing device , 32 per battery 31, 32 per battery

32,99 per battery hearing device 24 220 31, 32 per battery hearing

Medical Coverage Policy Hearing Aid Mandate

Medical Coverage Policy Hearing Aid Mandate Device/Equipment Drug Medical Surgery Test Other Effective Date: 6/1/2011 Policy Last Updated: 5/15/2012 Prospective review is recommended/required. Please check