2013 Minnesota Health Care Programs Hearing Aid Volume Purchase Contract Vendors
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- Logan Fowler
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1 MHCP Enrolled Providers Hearing Aid Contract Vendors, Models, Prices and Codes Hearing Aid Volume Purchase Contracts 2012 Contract (effective 9/1/12 through 8/31/13) 2011 Contract (effective 9/1/11 through 8/31/12) 2010 Contract (effective 9/1/10 through 8/31/11) 2009 Contract (effective 9/1/09 through 8/31/10) 2008 Contract (effective 7/1/08 through 8/31/09) 2007 Contract (effective 7/1/07 through 6/30/08) 2006 Contract (effective 4/1/06) (REVISED 2/12/07) All contracted hearing aids include a warranty: 12 months on loss and damage 24 months on parts and labor 2013 Minnesota Health Care Programs Hearing Aid Volume Purchase Contract Vendors Contract Vendors Contract # Terms Delivery Repair Warranty Audina Hearing Instruments Net 30 As Required 12 months 165 E Wildmere Ave Longwood, FL Vendor #: Contact: Katie McLarnon [email protected] Phone: FAX: Beltone Electronics GN Hearing Care Corp. dba Beltone Electronics 2601 Patriot Blvd. Glenview, IL Vendor #: Contact: Steve Brinkman [email protected] Phone: Fax: Hansaton Acoustics, Inc th Ave N, Ste. 110 Plymouth, MN Vendor #: Contact: Jennifer McKenna [email protected] Phone: Fax: Oticon, Inc. 580 Howard Ave Somerset, NJ Vendor #: Contact: Barbara Kania [email protected] Phone: Fax: % 10 Net 30 Contract Admin: John Laftsidis [email protected] As Required 12 months Net 30 As Required 12 months Net 30 As Required 12 months Contract Admin: Cathy Van Evra [email protected] Phone:
2 Phonak, LLC 4520 Weaver Parkway Warrenville, IL Vendor #: Contact: Tammy Cavazos Phone: Fax: ReSound GN Hearing Care Corp, dba ReSound 8001 E. Bloomington Freeway Bloomington, MN Vendor #: Contact: Stacey Larson Phone: ext 8864 Fax: Rexton Division of Siemens 5010 Cheshire Parkway N, #2 Plymouth, MN Vendor #: Contact: Jake Whitsitt Phone: ext 6261 Fax: Siemens Hearing Instruments 10 Constitution Ave Piscataway, NJ Vendor #: Contact: Jason Blusewicz or David Green Phone: Fax: Sonic Innovations 2501 Cottontail Lane Somerset, NJ Vendor #: Contact: Tammy Bender Phone: ext 3560 Fax: Starkey Laboratories, Inc Washington Avenue S Eden Prairie, MN Vendor #: Contact: Eric Stevens [email protected] Phone: ext ext 2855 Fax: Unitron Hearing, Inc th Ave N Plymouth, MN Vendor #: Contact: Jillian Wieser [email protected] Phone: ext Net 30 As Required 12 months Contract Admin: Jerrad Klumph [email protected] Phone: or Net 30 As Required 12 months Net 30 As Required 12 months Contract Admin: Cheryl Johnson [email protected] Phone: ext Net 30 As Required 12 months Contract Admin: Melissa Corbin [email protected] Phone: Net 30 As Required 12 months Net 30 As Required 12 months Contract Admin: Dan Thomas [email protected] Phone: Net 30 As Required 12 months Contract Admin: Jessie Thielbar [email protected] Phone:
3 Fax: Widex USA Inc. 185 Commerce Drive Hauppauge, NY Vendor #: Contact: Customer Service Phone: Fax: Net 30 As Required 12 months Contract Admin: Kostas Panagos Phone: This contract is available to the Minnesota Health Care Programs, State agencies, and to members of the State s Cooperative Purchasing Venture (CPV) program at the same price, terms and conditions.
4 MHCP Hearing Aid Contract Effective September 1, 2013 August 31, 2014 Revised 6/10/14 Submit claims exactly as the Model # appears on the contract. Most manufacturers have provided a model number in addition to the model name. Use the model number on all claim submissions. CROS/BiCROS Hearing Aids Oticon Repair rate: $100.00/unit Unitron Repair Rate: $150.00/unit V5180 V5220 BTE CROS BiCROS CROS Unit Price BiCROS Unit Price CROS Unit Price BiCROS Unit Price GoPro BTE $ $ Tandem 4 Cros Tandem4Cros $ N/A Go Pro VC $ $ Tandem 4 BiCros Tandem4BiCros N/A $ GoPro Power Direct $ $ GoPro Power OMNI $ $ Safari 300 Super Power $ $ Chili SP $ $ Ino $ $ Ino Power $ $ Ino Pro Power $ $ Ino Pro $ $ Acto $ $ Acto Power $ $ Get $ $ Get Power $ $ Nera $ $ Nera Power $ $ Sensei $ $ Sensei $ $ Sensei Pro $ $ Sensei Pro $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 1
5 CROS Hearing Aids V5170 ITE V5180 BTE CROS ITE V5170 CROS BTE V5180 Phonak Repair Rate: $110.00/unit Phonak Repair Rate: $110.00/unit CROS CROS CROS 13 - ITE $ CROS BTE C0.70 $ CROS 13 - ITE $ CROS BTE C0.50 $ CROS 13 - ITE $ CROS BTE C0.30 $ CROS ITE $ CROS H2O BTE $ CROS ITE $ CROS H2O BTE $ CROS ITE $ CROS H2O BTE $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 2
6 BTE Digital V5257 Digital BTE V5261 Digital BTE Audina Repair Rate: $150.00/unit Audina Repair Rate: $200.00/unit Intuition 2 BTEI2 $ $ Sparo 2+ OTES2plus OTES2plus-S $ $ Intuition 2FC BTEI2FC BTEI2FC-B BTEI2FC-G $ $ Sparo OTES4 OTES4-M OTES4-C OTES4-S $ $ Intuition 4+ BTEI4 BTEI4-B BTEI4-G $ $ SparoAD OTEAD OTEAD-C OTEAD-S $ $ Intuition 4AD BTEI4AD BTEI4AD-B BTEI4AD-G $ $ Sparo12 OTE12 OTE12-C OTE12-S $ $ Opti-Trim BTEOP BTEOP-B BTEOP-G Simplex 2P+ BTES2P $ $ $ $ FLX BTEFLX-G BTEFLX-C BTEFLX $ $ Simplex BTESD $ $ P+ BTE478 $ $ BTE478P $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 3
7 BTE Digital V5257 Digital BTE V5261 Digital BTE Beltone Repair Rate: $97.30/unit TURN TN1T75 Beige $ $ ORIGIN 3-85D Beige Brown Gray $ $ TURN TN3T85 Beige Brown Gray $ $ FORCE FRC95 Beige Brown Gray $ $ TURN TN3T95 Beige Brown Gray $ $ TRUE 3-66DW Beige Gray Sterling Grey $ $ CHANGE 62D Beige Gray Brown $ $ TRUE 6-62D Beige Gray Brown $ $ Origin 2-75D Beige Gray Brown $ $ TRUE 6-63DW Beige Gray Brown $ $ ORIGIN 2-85D Beige Gray Brown $ $ TRUE 6-64DW Beige Grey Brown $ $ ORIGIN 3-65D Beige Gray Brown $ $ TRUE 6-66DW Beige Gray Brown $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 4
8 BTE Digital V5257 Digital BTE V5261 Digital BTE Beltone Repair Rate: $97.30/unit ORIGIN 3-75D $ $ TRUE 6-78DW $ $ Beige Beige Gray Gray Brown Brown BTE Digital V5257 Digital BTE V5261 Digital BTE Hansaton Repair Rate: $100.00/unit Hansaton Repair Rate: $100.00/unit Base mp BTE Base mp $ $ Lumeo Power BTE Lumeo Power $ $ Base HP BTE Base HP $ $ Lumeo Slim BTE Lumeo Slim $ $ Cemia Power BTE Cemia Power $ $ Lumeo Mini BTE Lumeo Mini $ $ Cemia Slim BTE Cemia Slim $ $ Lumeo X-Mini RIC Lumeo X-Mini $ $ Cemia Mini BTE Cemia Mini $ $ Veneto Power BTE Veneto Power $ $ Cemia X-mini RIC Cemia X-Mini $ $ Veneto Slim BTE Veneto Slim $ $ Veneto Mini BTE Veneto Mini $ $ Vento X-Mini RIC Veneto X-Mini $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 5
9 BTE Digital V5257 Digital BTE V5261 Digital BTE Oticon Repair Rate: $100.00/unit Get $ $ Ino $ $ Get Power $ $ Ino RITE $ $ GoPro $ $ Ino mini BTE $ $ GoPro VC $ $ Ino minirite $ $ GoPro Power OMNI $ $ Ino Power BTE $ $ GoPro Power Direct $ $ Ino Pro BTE $ $ Safari 300 Super Power $ $ Ino Pro minirite $ $ Safari 600 Super Power $ $ Ino Pro Power $ $ Acto mini BTE $ $ Ino Pro RITE $ $ Acto Mini RITE $ $ Ino Pro mini BTE $ $ Acto RITE $ $ Chili SP $ $ Acto BTE $ $ Sumo DM $ $ Acto Power BTE $ $ Sensei $ $ Nera $ $ Sensei $ $ Nera mini $ $ Sensei RITE $ $ Nera Power $ $ Sensei PRO $ $ Nera RITE $ $ Sensei PRO $ $ Nera minirite $ $ Sensei PRO RITE $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 6
10 BTE Digital V5257 Digital BTE V5261 Digital BTE Phonak Repair Rate: $110.00/unit Resound Repair Rate: $95.00/unit Bolero Q50- P $ $ Bolero Q-50 SP $ $ Bolero Q50- M $ $ Vea 2 Standard Vea 2 Power Vea 3 Mini Vea 3 Standard Vea 3 Power Sparx Super Power VI Verso 5 Micro RIE BTE VE270-DVI VE280-DVI VE360-DI VE370-DVI VE380-DVI SP90-VI VO560-DR $ $ $ $ $ $ $ $ $ $ $ $ $ $ Dalia Verso 5 Mini RIE BTE VO561-DRW $ $ Micro M $ $ Verso 5 RIE BTE VO562-DRW $ $ Micro P $ $ Verso 5 Mini BTE VO567-DW $ $ SP $ $ Verso 5 M H $ $ VO577-DW $ $ Verso 5 Power VO588-DW $ $ Audeo Q T $ $ Verso 7 Micro RIE BTE Audeo Q $ $ VO760-DR $ $ Verso 7 Mini RIE BTE Audeo Q $ $ VO761-DRW $ $ Verso 7 RIE BTE Audeo Q T $ $ VO762-DRW $ $ Verso 7 Mini BTE Audeo Q $ $ VO767-DW $ $ Verso 7 BTE Audeo Q $ $ VO777-DW $ $ Verso 7 Power BTE VO788-DW $ $ Audeo S Verso 7 TS Micro RIE BTE Smart I F6 $ $ VOT760-DR $ $ Verso 7 TS Mini RIE BTE Smart III C0 $ $ VOT761-DRW $ $ Mini III C0 $ $ Verso 7 TS RIE BTE VOT762-DRW $ $ Yes III $ $ Verso 7 TS Mini BTE VOT767-DW $ $ Naida Q-50 RIC $ $ Verso 7 TS BTE VOT777-DW $ $ Naida Q-50 UP $ $ Verso 7 TS Power BTE VOT788-DW $ $ Naida Q-50 SP $ $ Naida Q-30 RIC $ $ Naida Q-30 UP $ $ Naida Q-30 SP $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 7
11 BTE Digital V5257 Digital BTE V5261 Digital BTE Phonak Repair Rate: $110.00/unit Resound Repair Rate: $95.00/unit Naida S I SP I UP III SP III UP CRT III $ $ $ $ $ $ $ $ $ $ Nios S H20 III $ $ Cassia Petite F6 $ $ Micro M $ $ Micro P $ $ SP $ $ M H $ $ Accessories: Custom Ear molds for BTE Acrylic $20.00/unit Silicone $24.00/unit MHCP Hearing Aid Contract_9/1/2013 8/31/2014 8
12 BTE Digital V5257 Digital BTE V5261 Digital BTE Rexton Repair Rate $155.00/unit Accord 12 2c M BGE BRN GR GNT SLV PRL CHL SB $ $ Day 6+ Open BGE GNT BRN SLV GR $ $ Accord 12 2c S Arena 1S Day 4+ Open BGE BRN GR GNT SLV PRL CHL SB BGE BRN GNT GR BGE BRN GNT GR SLV $ $ Day 6+ Free BGE BRN GNT GR SLV $ $ Day 6+ P BGE BRN GR SLV GNT $ $ Day 6+ HP BGE BRN GNT GR SLV $ $ $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/2014 9
13 BTE Digital V5257 Digital BTE V5261 Digital BTE Rexton Repair Rate $155.00/unit Day 4+ Free BGE $ $ Cobalt ECO+ RIC BGE $ $ BRN BRN GNT GR GR GNT SLV SLV Day 4+ P BGE $ $ BRN GNT GR SLV Day 4+ HP BGE $ $ BRN GNT GR SLV MHCP Hearing Aid Contract_9/1/2013 8/31/
14 BTE Digital V5257 Digital BTE V5261 Digital BTE Rexton, cont d Repair Rate: $155.00/unit Model Name Model Name Onyx ECO+RIC BGE BRN CHL GNT GR PRL SB SLV $ $ Bridge 8+ P BGE GNT GR BRN SLV PRL SB CHL $ $ Onyx 8+RIC BGE BRN CHL GNT GR PRL SB SLV $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
15 BTE Digital V5257 Digital BTE V5261 Digital BTE Siemens Repair Rate: $95.00/unit Sonic Repair Rate: $145.00/unit Life 3mi Life 3mi $ $ ion $ $ Nitro 301 SP Nitro 301 $ $ Velocity $ $ Pure 3mi Pure 3mi $ $ Velocity $ $ Aquaris 3mi Aquaris 3mi $ $ Velocity 6 mini $ $ Pure Carat 301 Xcel Pure Carat 301 $ $ Flip 60 mini RIC $ $ Orion M Orion M $ $ Flip 80 mini RIC $ $ Orion P Orion P $ $ Endura 6 BTEP $ $ Pure 101 Xcel Pure 101 $ $ Endura 12 BTEP $ $ Orion S* Orion S $ $ Sirion M* Sirion M $ $ Sirion P* Sirion P $ $ Sirion S* Sirion S $ $ Motion M 3 mi* Motion 3mi M $ $ Motion SX 3 mi* Motion 3mi SX $ $ Motion P 3 mi* Motion 3mi P $ $ Motion PX 3 mi* Motion 3mi PX $ $ Nitro 3 mi* Nitro 3 mi $ $ *Available 11/1/13 MHCP Hearing Aid Contract_9/1/2013 8/31/
16 Starkey Repair Rate: $84.99/unit V5257 Digital BTE V5261 Digital BTE 3 Series 3 Series Ignite Series Ignite Series 70 mini BTE 3 Series 70 mbte $ $ mini BTE Ignite 20 mini BTE $ $ RIC 3 Series 70 RIC $ $ RIC Ignite 20 RIC 13 $ $ i70 mini BTE 3 Series i70 mbte $ $ RIC 312 Ignite 20 RIC 312 $ $ i70 RIC 3 Series i70 RIC $ $ mini BTE Ignite 30 mini BTE $ $ RIC 3 Series 90 RIC $ $ RIC Ignite 30 RIC 13 $ $ mini BTE 3 Series 90 mbte $ $ RIC Ignite 30 RIC 312 $ $ i90 mini BTE 3 Series i90 mbte $ $ i20 RIC 13 Ignite i20 RIC 13 $ $ i90 RIC 3 Series i90 RIC $ $ i20 RIC 312 Ignite i20 RIC 312 $ $ mini BTE 3 Series 110 mbte $ $ i30 RIC 13 Ignite i30 RIC 13 $ $ RIC 3 Series 110 RIC $ $ i30 RIC 312 Ignite i30 RIC 312 $ $ i110 mini BTE 3 Series i110 mbte $ $ BTE 13 Ignite 20 BTE $ $ i110 RIC 3 Series i110 RIC $ $ Power BTE Ignite 20 PowerBTE $ $ i20 BTE 3 Series i20 BTE $ $ Power Plus BTE Ignite 20 Power+BTE $ $ mini BTE Series 20 mbte $ $ BTE 13 Ignite 30 BTE $ $ i20 mini BTE Series i20 mbte $ $ Power BTE Ignite 30 PowerBTE $ $ RIC 3 Series 20 RIC $ $ Power Plus BTE 13 Ignite 30 Power+ BTE $ $ i20 RIC 3 Series i20 RIC $ $ mini BTE Series 30 mbte $ $ Xino 30 RIC Series 30 RIC $ $ RIC 10 Xino 70 microric $ $ i30 BTE 3 Series i30 BTE $ $ i70 micro RIC 312 Xino i70 micro RIC $ $ i30 mini BTE 3 Series i30 mbte $ $ RIC 10 Xino 90 microric $ $ i30 RIC Series i30 RIC $ $ i90 micro RIC 312 Xino i90 micro RIC $ $ i70 BTE 3 Series i70 BTE $ $ RIC 10 Xino 110microRIC $ $ i90 BTE 3 Series i90 BTE $ $ i110 micro RIC Xino i110 micro RIC $ $ i110 BTE 3 Series i110 BTE $ $ Tinnitus RIC Xino Tinnitus $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
17 BTE Digital V5257 Digital BTE V5261 Digital BTE Starkey, cont d Repair Rate: $84.99/unit Wi Series Wi Series i70 RIC 13 WiSeriesi70 RIC13 $ $ i WiSeriesi70 RIC312 $ $ i90 RIC 13 WiSeries i90 RIC 13 $ $ i90 RIC 312 WiSeriesi90 RIC312 $ $ i110 RIC 13 WiSeries i110 RIC13 $ $ i110 RIC 312 WiSeriesi110 RIC312 $ $ X Series X Series 70 mini BTE X Series 70 mbte $ $ RIC X Series 70 RIC 13 $ $ RIC X Series 70 RIC 312 $ $ mini BTE X Series 90 mbte $ $ RIC X Series 90 RIC 13 $ $ RIC X Series 90 RIC 312 $ $ mini BTE X Series 110 mbte $ $ RIC X Series 110 RIC 13 $ $ RIC X Series 110 RIC 312 $ $ BTE X Series 70 BTE $ $ Power BTE X Series70PowerBTE $ $ Power Plus X SRS 70 PWR+ BTE $ $ BTE 13 X Series 90 BTE $ $ Power BTE 13 X Series90PowerBTE $ $ Power Plus BTE 13 X SRS 90 PWR+ BTE $ $ BTE 13 X Series 110 BTE $ $ Power BTE 13 X Series110PowerBTE $ $ Power Plus BTE 13 X SRS110 PWR+ BTE $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
18 BTE Digital Unitron Repair Rate: $75.00/unit V5257 Digital BTE Unitron Repair Rate: $75.00/unit V5261 Digital BTE Model Name Model # Model Name Model # Moxi E Kiss CRTSP MoxiEKissSP $ Moxi E Kiss CRTSP MoxiEKissSP2 $ Moxi E Kiss CRTP MoxiEKissP $ Moxi E Kiss CRTP MoxiEKissP2 $ Moxi E CRTS MoxiEKissS $ Moxi E Kiss CRTS MoxiEKissS2 $ Moxi 6 Kiss CRTSP Moxi6KissSP $ Moxi 6 Kiss CRTSP Moxi6KissSP2 $ Moxi 6 Kiss CRTP Moxi6KissP $ Moxi 6 Kiss CRTP Moxi6KissP2 $ Moxi 6 CRTS Moxi6KissS $ Moxi 6 Kiss CRTS Moxi6KissS2 $ Moxi 12 Kiss CRTSP Moxi12KissSP $ Moxi 12 Kiss CRTSP Moxi12KissSP2 $ Moxi 12 Kiss CRTP Moxi12KissP $ Moxi 12 Kiss CRTP Moxi12KissP2 $ Moxi 12 Kiss CRTS Moxi12KissS $ Moxi 12 Kiss CRTS Moxi12KissS2 $ MAXe Super Power BTE MaxESP $ MAXe Super Power BTE MaxESP2 $ MAXe Super Power BTEM MaxESPM $ MAXe Super Power BTEM MaxESPM2 $ MAX6 Super Power BTE Max6SP $ MAX6 Super Power BTE Max6SP2 $ MAX6 Super Power BTEM Max6SPM $ MAX6 Super Power BTEM Max6SPM2 $ MHCP Hearing Aid Contract_9/1/2013 8/31/
19 BTE Digital Unitron Repair Rate: $75.00/unit V5257 Digital BTE Unitron Repair Rate: $75.00/unit V5261 Digital BTE Model Name Model # Model Name Model # Shine + HP ShineHPBTE $ Shine + HP ShineHPBTE2 $ Shine + ShineBTE $ Shine + ShineBTE2 $ Shine + Moda II ShineModa $ Shine + Moda II ShineModa2 $ Moxi E CRT SP MoxiECRTSP $ Moxi E CRT SP MoxiESP2 $ Moxi E CRT P MoxiECRTP $ Moxi E CRT P MoxiEP2 $ Moxi E CRT MoxiECRT $ Moxi E CRT MoxiE2 $ Moxi 6 CRT HP Moxi6CRTHP $ Moxi 6 CRT HP Moxi6HP2 $ Moxi 6 CRT P Moxi6CRTP $ Moxi 6 CRT P Moxi6P2 $ Moxi 6 CRT S Moxi6CRT $ Moxi 6 CRT S Moxi62 $ Moxi 12 CRT HP Moxi12CRTHP $ Moxi 12 CRT HP Moxi12HP2 $ Moxi 12 CRT P Moxi12CRTP $ Moxi 12 CRT P Moxi12P2 $ Moxi 12 CRT S Moxi12CRT $ Moxi 12 CRT S Moxi122 $ Quantum E HPBTE QEHPBTE $ Quantum E HPBTE QEHPBTE2 $ Quantum E S BTE QEPBTE $ Quantum E S BTE QEPBTE2 $ Quantum E M BTE QEBTE $ Quantum E M BTE QEBTE2 $ Quantum 6 HP Q6HPBTE $ Quantum 6 HP Q6HPBTE2 $ Quantum 6 Q6BTE $ Quantum 6 Q6BTE2 $ Quantum 6 Micro Q6Micro $ Quantum 6 Micro Q6Micro2 $ Quantum 12 HP Q12HPBTE $ Quantum 12 HP Q12HPBTE2 $ Quantum 12 Q12BTE $ Quantum 12 Q12BTE2 $ Quantum 12 Micro Q12Micro $ Quantum 12 Micro Q12Micro2 $ MHCP Hearing Aid Contract_9/1/2013 8/31/
20 BTE Digital V5257 Digital BTE V5261 Digital BTE Widex Repair Rate: $ per unit Menu 3 ME3-m ME3-m $ $ Clear 220 C2-9 std w/o VC C-29 $ $ Menu 3 ME3-9 ME3-9 $ $ Clear 220 C2-9 std with VC C29-VC $ $ Menu 3 ME3-19 ME3-19 $ $ Clear 220 C2 MR micro w/clearband w/o VC C2-MR CB $ $ Mind 220 m2-9 std Power digital w/o VC m2-9 $ $ Clear 220 C2 MR micro w/o VC C2-MR $ $ Mind 220 m2-9 std Power digital w/ VC m2-9vc $ $ Clear 220 C2-PA w/o VC C2-PA $ $ Mind 220 m2-19 Power digital w/o VC m2-19 $ $ Clear 220 C2-FS C2-FS $ $ Mind 220 m2-19 Power digital w/ VC m2-19vc $ $ Dream BTW w/vc D1-9-VC $ $ Mind 220 m2-m micro w/ program button m2-m $ $ Dream BTE w/o VC D1-9 $ $ Dream 110 D1-FS rcvr in ear D1-FS $ $ Dream 110m-CB micro ClearBand D1-MR CB $ $ Dream 110 Fashion BTE w/vc D1FA-VC $ $ Super 220, SP receiver S2-VS-SP $ $ Super 220, P receiver S2-VS-P $ $ Super 220, SP receiver, DAI S2-VSD-SP $ $ Super 220, P receiver, DAI S2-VSD-P $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
21 ITE Digital V5256 Digital ITE V5260 Digital ITE Audina Full Shell Repair Rate: $100.00/unit Beltone Full Shell Repair Rate: $97.30/unit Simplex Simplex FC Intuition 2+ Intuition 2FC+ Intuition 4+ Intuition 4AD Intuition 12 Intuition 12AD 312S77 312S75 312H22 312H23 312H24plus 312H24A 312H28 312H28A $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ORIGIN 2 Optima ORIGIN 3 Optima TRUE 3 Optima TRUE 6 Optima Beltone Half-Shell Repair Rate: $97.30/unit OR2-FS-45 OR3-FS-45 TR3-FS-45 TR6-FS-45 $ $ $ $ $ $ $ $ Audina Half-Shell Repair Rate: $100.00/unit ORIGIN 2 Optima ORIGIN 3 Optima TRUE 3 Optima TRUE 6 Optima OR2-FS-45-HS OR3-FS-45-HS TR3-FS-45-HS TR6-FS-45-HS $ $ $ $ $ $ $ $ Beltone Low Profile Repair Rate: $97.30/unit Simplex Simplex FC Intuition 2+ Intuition 2FC+ Intuition 4+ Intuition 4AD Intuition 12 Intuition 12AD 312S77 312S75 312H22 312H23 312H24plus 312H24A 312H28 312H28A $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ ORIGIN 2 Optima ORIGIN 3 Optima TRUE 3 Optima TRUE 6 Optima OR2-FS-45-LP OR3-FS-45-LP TR3-FS-45-LP TR6-FS-45-LP $ $ $ $ $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
22 ITE Digital V5256 Digital ITE V5260 Digital ITE Hansaton Full Shell Repair Rate: $100.00/unit Cemia Lumeo Veneto Cemia ITE CBDMIC Cemia ITE CBTC Cemia ITE CBPHCO Cemia ITE CBVC Cemia ITE CBPB Lumeo ITE CBDMIC Lumeo ITE CBTC Lumeo ITE CBPHCO Lumeo ITE CBVC Lumeo ITE CBPB Veneto ITE CBDMIC Veneto ITE CBTC Veneto ITE CBPHCO Veneto ITE CBVC Veneto ITE CBPB Hansaton Half-Shell Repair Rate: $100.00/unit $ $ Cemia Cemia HS CBDMIC Cemia HS CBTC Cemia HS CBPHCO Cemia HS CBVC Cemia HS CBPB $ $ Lumeo Lumeo HS CBDMIC Lumeo HS CBTC Lumeo HS CBPHCO Lumeo HS CBVC Lumeo HS CBPB $ $ Veneto Veneto HS CBDMIC Veneto HS CBTC Veneto HS CBPHCO Veneto HS CBVC Veneto HS CBPB $ $ $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
23 ITE Digital V5256 Digital ITE V5260 Digital ITE Hansaton Low Profile Repair Rate: $100.00/unit Cemia Cemia LP CBDMIC Cemia LP CBTC Cemia LP CBPHCO Cemia LP CBVC Cemia LP CBPB $ $ Lumeo Veneto Lumeo LP CBDMIC Lumeo LP CBTC Lumeo LP CBPHCO Lumeo LP CBVC Lumeo LP CBPB Veneto LP CBDMIC Veneto LP CBTC Veneto LP CBPHCO Veneto LP CBVC Veneto LP CBPB $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
24 ITE Digital V5256 Digital ITE V5260 Digital ITE Oticon Full Shell Repair Rate: $100.00/unit No additional charge for optional volume control Oticon Half Shell Repair Rate: $100.00/unit No additional charge for optional volume control GOPro FS Nera FS Nera FS Power Oticon Low Profile Repair Rate: $100.00/unit P $ $ $ $ $ $ No additional charge for optional volume control unit price GO Pro LP $ $ GO Pro LP Power P $ $ Get LP $ $ Get LP Power P $ $ Ino LP $ $ Ino LP Power P $ $ Ino Pro LP $ $ Ino Pro LP Power P $ $ Acto LP $ $ Acto LP Power P $ $ GOPro HS Power GOPro HS Get HS Get HS Power Ino HS Ino HS Power Ino Pro HS Ino Pro HS Power Acto HS Acto HS Power Nera HS Nera HS Power P P P P P P $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
25 ITE Digital V5256 Digital ITE V5260 Digital ITE Phonak Full Shell Repair Rate: $110.00/unit Phonak Half Shell Repair Rate: $110.00/unit Dalia 13 UZ $ $ Dalia 312 Petite $ $ Cassia 13 UZ $ $ Dalia 312 UZ Petite $ $ Dalia $ $ Dalia 312 UZ $ $ Cassia 312 Petite $ $ Cassia 312 UZ Petite $ $ Cassia $ $ Cassia 312 UZ $ $ Virto Q NW $ $ Virto Q $ $ Virto Q $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
26 ITE Digital V5256 Digital ITE V5260 Digital ITE ReSound Full Shell Repair Rate: $95.00/unit ReSound Half-Shell Repair Rate: $95.00/unit Vea 2 VE250 $ $ Vea 2 VE250HS $ $ Vea 2 Directional VE250-D $ $ Vea 2 Directional VE250HS-D $ $ Vea 2 Power VE250-P $ $ Vea 2 Power VE250HS-P $ $ Vea 2 Directional Power VE250-DP $ $ Vea 2 Directional Power VE250HS-DP $ $ Vea 3 VE350 $ $ Vea 3 VE350HS $ $ Vea 3 Directional VE350-D $ $ Vea 3 Directional VE350HS-D $ $ Vea 3 Power VE350-P $ $ Vea 3 Power VE350HS-P $ $ Vea 3 Directional Power VE350-DP $ $ Vea 3 Directional Power VE350HS-DP $ $ Verso 5 VO550 $ $ Verso 5 VO550HS $ $ Verso 5 Directional VO550-D $ $ Verso 5 Directional VO550HS-D $ $ Verso 5 Wireless VO550-W $ $ Verso 5 Wireless VO550HS-W $ $ Verso 5 Wireless Directional VO550-DW $ $ Verso 5 Wireless Directional VO550 HS-DW $ $ Verso 5 Power VO550-P $ $ Verso 5 Power VO550HS-P $ $ Verso 5 Directional Power VO550-DP $ $ Verso 5 Directional Power VO550HS-DP $ $ Verso 5 Wireless Power VO550-PW $ $ Verso 5 Wireless Power VO550HS-PW $ $ Verso 5 Wireless Directional Pwr VO550-DPW $ $ Verso 5 Wireless Directional Pwr VO550HS-DPW $ $ Verso 7 VO750 $ $ Verso 7 VO750HS $ $ Verso 7 Directional VO750-D $ $ Verso 7 Directional VO750HS-D $ $ Verso 7 Wireless VO750-W $ $ Verso 7 Wireless VO750HS-W $ $ Verso 7 Wireless Directional VO750-DW $ $ Verso 7 Wireless Directional VO750HS-DW $ $ Verso 7 Power VO750-P $ $ Verso 7 Power VO750HS-P $ $ Verso 7 Directional Power VO750-DP $ $ Verso 7 Directional Power VO750HS-DP $ $ Verso 7 Wireless Power VO750-PW $ $ Verso 7 Wireless Power VO750HS-PW $ $ Verso 7 Wireless Directional Pwr VO750-DPW $ $ Verso 7 Wireless Directional Pwr VO750HS-DPW $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
27 ITE Digital V5256 Digital ITE V5260 Digital ITE Rexton Full Shell Repair Rate: $155.00/unit Rexton Half Shell Repair Rate: $155.00/unit Accord 12 2c 0202G7-RX-12 $ $ Accord 12 12c 0202G7-RX-20 $ $ Arena 1S 0202CT-RX-12 $ $ Arena 1S 0202CT-RX-20 $ $ Day E4-RX-12 $ $ Day E4-RX-20 $ $ Day E6-RX-12 $ $ Day E6-RX-20 $ $ Day 6+ Energy 0202E7-RX-12 $ $ Day 6+ Energy 0202E7-RX-20 $ $ Directional Microphone 0211D No charge No charge Directional Microphone 0211D No charge No charge 0211E Twin No charge No charge 0211E Twin No charge No charge Telecoil 0503TC No charge No charge Telecoil 0503TC No charge No charge Switchless Telecoil 0503TS No charge No charge Switchless Telecoil 0503TS No charge No charge Siemens Full Shell Repair Rate: $95.00/unit Siemens Half Shell Repair Rate: $95.00/unit unit price unit price Phoenix G3 Phoenix G3 $ $ Phoenix G3 HS Phoenix G3 HS $ $ Intuis Intuis $ $ Intuis HS Intuis HS $ $ Motion 301 Motion 301 ITE $ $ Motion 301 Motion 301 HS $ $ Nitro 301 Nitro 301 $ $ Nitro 301 Nitro 301 HS $ $ Insio 3 mi* Insio 3mi ITE $ $ Insio 3mi* Insio 3mi HS $ $ Orion Custom* Orion ITE $ $ Orion Custom* Orion HS $ $ Sirion Custom* Sirion ITE $ $ Sirion Custom* Sirion HS $ $ Nitro 3 mi Custom* Nitro 3 mi ITE $ $ Nitro 3mi Custom* Nitro 3mi HS $ $ *Available 11/1/13 *Available 11/1/13 MHCP Hearing Aid Contract_9/1/2013 8/31/
28 ITE Digital V5256 Digital ITE V5260 Digital ITE Sonic Full Shell Repair Rate: $145.00/unit Sonic Half Shell Repair Rate: $145.00/unit Velocity 4 ITED $ $ Velocity 4 HSD $ $ Velocity 4 ITEPD $ $ Velocity 6 HSD $ $ Velocity 6 ITEPD $ $ Velocity 6 ITED $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
29 Starkey Full Shell Repair Rate: $84.99/unit V5256 V5260 Starkey Half Shell Repair Rate: $84.99/unit V5256 V5260 Wi Series Wi Series Wi Series Wi Series i70 ITE Wi Series i70 ITE $ $ i70 HC Wi Series i70 HC $ $ i90 ITE Wi Series i90 ITE $ $ i90 HC Wi Series i90 HC $ $ i110 ITE Wi Series i110 ITE $ $ i110 HC Wi Series i110 HC $ $ Ignite Ignite Ignite Ignite 20 ITE Ignite 20 ITE $ $ HC Ignite 20 HC $ $ ITE Ignite 30 ITE $ $ HC Ignite 30 HC $ $ i20 ITE Ignite i20 ITE $ $ i20 HC Ignite i20 HC $ $ i30 ITE Ignite i30 ITE $ $ i30 HC Ignite i30 HC $ $ X Series X Series X Series X Series 70 ITE X Series 70 ITE $ $ HC X Series 70 HC $ $ ITE X Series 90 ITE $ $ HC X Series 90 HC $ $ ITE X Series 110 ITE $ $ HC X Series 110 HC $ $ Series 3 Series 3 Series 3 Series i20 ITE 3 Series i20 ITE $ $ i20 HC 3 Series i20 HC $ $ i30 ITE 3 Series i30 ITE $ $ i30 HC 3 Series i30 HC $ $ i70 ITE 3 Series i70 ITE $ $ i70 HC 3 Series i70 HC $ $ i90 ITE 3 Series i90 ITE $ $ i90 HC 3 Series i90 HC $ $ i110 ITE 3 Series i110 ITE $ $ i110 HC 3 Series i110 HC $ $ ITE 3 Series 20 ITE $ $ HC 3 Series 20 HC $ $ ITE 3 Series 30 ITE $ $ HC 3 Series 30 HC $ $ ITE 3 Series 70 ITE $ $ HC 3 Series 70 HC $ $ ITE 3 Series 90 ITE $ $ HC 3 Series 90 HC $ $ ITE 3 Series 110 ITE $ $ HC 3 Series 110 HC $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
30 ITE Digital V5256 Digital ITE V5260 Digital ITE Unitron Full Shell Repair Rate: $75.00/unit V5256 Digital ITE Unitron Full Shell Repair Rate: $75.00/unit V5260 Digital ITE Model Name Model # unit price Model Name Model # unit price Shine + FS ShineFS $ Shine + FS ShineFS2 $ Shine + FS P ShineFSP $ Shine + FS P ShineFSP2 $ Quantum 6FS Q6FS $ Quantum 6FS Q6FS2 $ Quantum 12FS Q12FS $ Quantum 12FS Q12FS2 $ Quantum E FS QEFS $ Quantum E FS QEFS2 $ Unitron Half Shell Repair Rate: $75.00/unit V5256 Digital ITE Unitron Half Shell Repair Rate: $75.00/unit V5260 Digital ITE Model Name Model # unit price Model Name Model # unit price Shine + HS ShineHS $ Shine + HS ShineHS2 $ Shine + HS P ShineHSP $ Shine + HS P ShineHSP2 $ Quantum 6HS Q6HS $ Quantum 6HS Q6HS2 $ Quantum 12HS Q12HS $ Quantum 12HS Q12HS2 $ Quantum E HS QEHS $ Quantum E HS QEHS2 $ Unitron Low Profile Repair Rate: $75.00/unit V5256 Digital ITE Unitron Low Profile Repair Rate: $75.00/unit V5260 Digital ITE Model Name Model # unit price Model Name Model # Shine + LP ShineLP $ Shine + LP ShineLP2 $ Shine + LP P ShineLPP $ Shine + LP P ShineLPP2 $ Quantum 6 LP Q6LP $ Quantum 6 LP Q6LP2 $ Quantum 12 LP Q12LP $ Quantum 12 LP Q12LP2 $ Quantum E LP QELP $ Quantum E LP QELP2 $ MHCP Hearing Aid Contract_9/1/2013 8/31/
31 ITE Digital V5256 Digital ITE V5260 Digital ITE WIdex Full Shell Repair Rate: $ Widex Half Shell Repair Rate: $ Menu 3 ME3-XF Standard Power Mind 220 m2-x Standard Power Clear 220 Dream 110 ITE ME3-XF m2-xf C2-XF D1-XPF $ $ $ $ $ $ $ $ Menu 3 ME3-XH Standard Power Mind 220 m2-x Standard Power Clear 220 Digital ITE Dream 110 ITE ME3-XH m2-xh C2-XH D1-XPH $ $ $ $ $ $ $ $ ITE Digitally Programmable V5246 ITE V5252 ITE Audina Repair Rate: $75.00 Class D Class A 312S38 312S26 $ $ $ $ On the Body Rexton Repair rate: $155.00/unit V5030, body worn, air conduction Unit price Fusion PP $ MHCP Hearing Aid Contract_9/1/2013 8/31/
32 Rexton Repair rate: $155.00/unit V5040, body worn, bone conduction Unit price Fusion PP $ Rexton Repair rate: $155.00/unit V5120, body worn Unit price Fusion PP $ Personal Frequency Modulations (FM) Systems Always require authorization refer to MHCP Provider Manual for more information V5274 Assistive Listening Device, not otherwise specified Siemens Hearing Instruments Repair Rate: $0.00 Repair Warranty: 24 months Unit price Comfort Mini DT20 WR Comfort Body DH10 WR Comfort Body DH10 WR with Neckloop Comfort Mini DM 05 WT Comfort DM 10 WT Comfort Duett w/neckloop Comfort Duett w/head & Earphones Comfort Contego R900 w/neckloop WR & WT F00727 F00503 F00535 F00499 F00501 F00689 F00654 F00113 $ $ $ $ $ $ $ $ MHCP Hearing Aid Contract_9/1/2013 8/31/
33 Personal Frequency Modulations (FM) Systems Always require authorization refer to MHCP Provider Manual for more information Oticon Repair rate: $100.00/unit V5288 Assistive Listening Device Personal FM/DM Transmitter Unit price Amigo T10 Amigo T $ $ Oticon Repair rate: $100.00/unit V5285 Assistive Listening Device Personal FM/DM Direct Audio Input Receiver Unit price Amigo R5 Amigo R2 Amigo R2B R R2B $ $ $ Oticon Repair rate: $100.00/unit V5283 Assistive Listening Device Personal FM/DM Neck, Loop Induction Receiver Unit price Amigo Arc $ MHCP Hearing Aid Contract_9/1/2013 8/31/
34 Other Hearing Aid Codes V5050 Analog ITE Always require authorization V5060 V5070 V5080 V5090 V5100 V5110 V5130 V5140 V5150 V5190 V5230 V5246 V5252 V5273 V5274 Analog BTE Air Conductive hearing aid in Glasses Bone Conductive hearing aid in Glasses Dispensing Fee, unspecified hearing aid (for FM System or Vibrotactile Device) Hearing aid, bilateral, body worn Dispensing fee, bilateral Analog ITE Analog BTE hearing aid in glasses CROS, in glasses BiCROS, in Glasses digitally programmable ITE digitally programmable ITE Assistive listening device, for use with cochlear implant Assistive listening device, not otherwise specified V5298 Hearing Aid, not otherwise classified Dispensing Fee V5160 V5200 V5240 V5241 Dispensing Fee, CROS Dispensing Fee BiCROS Dispensing Fee Dispensing Fee, any type General Hearing Aid Services V5011 V5014 V5264 V5266 V5267 V5275 V5299 Hearing aid checks (use to bill reprogramming-may not be billed during trial period) Repair/modification of a hearing aid: to be used only for billing battery doors and re-case/remake Ear mold/insert, not disposable, any type Batteries (see manual for coverage) Hearing Aid Supplies/Accessories Ear Impression, each Hearing Service, miscellaneous If hearing aid requires authorization, dispensing fee requires authorization See manual for coverage. MHCP Hearing Aid Contract_9/1/2013 8/31/
35 Non-covered hearing aid services V5242 Analog,, CIC V5243 Analog, ITC V5244 Digitally Programmable Analog, CIC V5245 Digitally Programmable Analog,, ITC V5248 Analog, CIC V5249 Analog, ITC V5250 Digitally Programmable Analog, CIC V5251 Digitally Programmable Analog, ITC V5254 Digital, CIC V5255 Digital, ITC V5258 Digital, ITC V5259 Digital, ITC V5262 Disposable,, any type V5263 Disposable,, any type V5265 Ear mold/insert, disposable, any type V5268 Assistive Listening Device, telephone amplifier, any type V5269 Assistive listening device, alerting type, any type V5270 Assistive listening device, television amplifier, any type V5271 Assistive listening device, television caption decoder V5272 Assistive listening device, TDD MHCP Hearing Aid Contract_9/1/2013 8/31/
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