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September 2026 TMPPM Update for Hearing Aid Services
Act
by Sep 1, 2026
Effective date
Sep 1, 2026
Identified
Aug 5, 2026
Summary
Effective September 1, 2026, TMHP is updating hearing aid services billing rules to deny claims for procedure codes 92628 and 92631 when submitted on the same date of service for the same ear as specific conflicting procedure codes. This creates new claim denial triggers that billing staff must monitor to avoid rejected claims.
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What to do
by Sep 1, 2026 · 6 steps
01Billing team must implement system edits to prevent claims submission errors and flag potential denials.
02Update billing software to add automated denial rules: deny CPT 92628 when billed on same DOS/same ear as CPT 92622, 92623, 92626, 92627, 92634, 92635, 92636, 92637, or HCPCS V5010; deny CPT 92631 when billed on same DOS/same ear as CPT 92622, 92623, 92626, 92627, 92636, or 92637.
03Create provider alerts/education noting these code combinations are mutually exclusive per ear on the same date.
04Update encounter forms or claim submission checklists to remind audiology providers to verify they are not billing conflicting codes on the same ear.
05Configure system to route any claims triggering these combinations to manual review before submission.
06For MCO-contracted services, contact individual MCOs to verify they have adopted these same limitations, as MCO administrative procedures may vary.
If missed: Failure to implement these edits will result in automatic claim denials from TMHP.
Codes mentioned
92628926319262292623926269262792634926359263692637V5010
Original notice
September 2026 TMPPM Update for Hearing Aid Services
tmhp.com · Always check the source before changing claims.