Limitations and Claim Filing Requirements for New Hearing Device Procedure Codes
AI Summary
Texas Medicaid is implementing new limitations and claim filing requirements for hearing device procedure codes effective April 1, 2026. Key changes include removing modifier requirements for certain codes, implementing frequency limitations, establishing add-on procedure requirements, and age-based restrictions for some services.
Action Required
Before April 1, 2026: Billing team must update system rules to remove modifier requirements for codes 92628, 92631, and 92634. Configure add-on procedure validations requiring primary codes for 92629, 92632, 92635, 92637, 92638, and 92639. Implement frequency limits: one hearing aid fitting per 5-year rolling period, two post-fitting follow-ups per calendar year. Add age-based restrictions for codes 92639 and 92641 (bilateral services only for patients 20 and under). Update encounter forms to reflect new same-day service denials. Claims submitted before April 1, 2026 will be automatically reprocessed by TMHP.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
ent