NC Medicaid has temporarily modified the delivery of specific optical and hearing aid services to reduce in-person visits for Medicaid and NC Health Choice beneficiaries due to the state of emergency related to COVID-19. These temporary changes are retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when these modifications are rescinded. When the temporary modifications end, all face-to-face service requirements resume.
NC Medicaid has considered the recommendations of related licensing boards and associations and conducted a close evaluation of in-person optical and hearing aid care to develop the following modifications.
This bulletin outlines guidance for the delivery of specific optical and hearing aid services in the following clinical coverage policies:
- Routine Eye Exam and Visual Aids for Beneficiaries Under 21 Years of Age
- Routine Eye Examination and Visual Aids for Beneficiaries 21 and Older
- NC Medicaid Hearing Aid Services
Optical Services
Temporary changes to optical services allow providers to ship specific visual aids to beneficiaries and bill NC Medicaid for shipping charges. These temporary changes are not mandatory and are available at the provider’s discretion.
Recently Fit New Visual Aids (Eyeglasses and Medically Necessary Contact Lenses) Not Yet Dispensed
The provider:
- Must inspect the visual aids upon receipt and verify that all parameters are correct prior to shipping.
- May ship recently fit new visual aids to the beneficiary’s home.
- Must notify the beneficiary that visual aids are being shipped and provide a timeframe for anticipated delivery.
Replacement Visual Aids (Eyeglasses and Medically Necessary Contact Lenses)
The provider:
- May accept requests for replacement eyeglasses or medically necessary contact lenses over the telephone or other means that are not in-person.
- Is not required to visually evaluate damaged eyeglasses. A description may be provided over the telephone or other means that are not in-person. “COVID-19” should be recorded in the Notes field of the prior approval request as the reason the evaluation could not occur.
- Is not required to send defective eyeglasses to Nash Optical Laboratory for warranty assessment prior to receiving warranty replacements eyeglasses or eyeglasses components.
- Must inspect the visual aids upon receipt and verify that all parameters are correct, prior to shipping.
- May ship replacement visual aids to the beneficiary’s home.
Eyeglasses Repair
The provider:
- May accept requests for eyeglasses repair over the telephone or other means that are not in-person.
- May accept the eyeglasses needing repair via shipment from the beneficiary.
- May ship the repaired eyeglasses to the beneficiary’s home.
Prior Approval
- Requests for prior approval for shipping charges must include “Shipping charges” in the Notes field of the prior approval request.
- Prior approval requirements for optical services delivered in-person will still apply to services when items are shipped to the beneficiary’s home.
Billing
The provider:
- Must bill the usual and customary dispensing fee for new, replacement and repaired visual aids.
- May bill V2799 for shipping charges incurred when shipping visual aids to the beneficiary.
- Is not required to submit an invoice for shipping charges with the claim. However, a record of shipping charges must be maintained with the beneficiary’s patient record. The maximum allowed amount is $13.15.
Provider Assistance
If the original fitting provider is not accessible, and the beneficiary must go through a new provider for replacement of visual aids, the new provider may obtain the original frame, lens (eyeglasses or contact lens) and fitting parameters from NC Medicaid by calling (919) 527-7669.
Hearing Aid Services
Temporary changes in hearing aid services allow providers to ship specific hearing aid services to beneficiaries and bill NC Medicaid for shipping charges. These temporary changes are not mandatory and are available at the provider’s discretion.
Recently Fit New Hearing Aids Not Yet Dispensed
The provider:
- Must submit a separate prior approval request for shipping charges (see Prior Approval guidance, below).
- May ship recently fit new hearing aids to the beneficiary’s home.
- Must notify the beneficiary that the hearing aids are being shipped and provide a timeframe for anticipated delivery.
Replacement Hearing Aids, Ear Molds, Batteries, Supplies and Accessories
The provider:
- May accept requests for replacement hearing aids, ear molds, batteries, supplies and accessories over the telephone or other means that are not in-person.
- May ship replacement hearing aids, ear molds, batteries, supplies and accessories to the beneficiary’s home.
Hearing Aid Repair
The provider:
- May accept requests for hearing aid repair over the telephone or other means that are not in-person.
- May accept the hearing aid needing repair via shipment from the beneficiary.
- May ship the repaired hearing aid to the beneficiary’s home.
Prior Approval
- Requests for prior approval for shipping charges must include V5299 and “Shipping charges” in the Notes field of the prior approval request.
- Prior approval requirements for hearing aid services delivered in-person will still apply to hearing aid services when items are shipped to the beneficiary’s home.
Billing
The provider:
- Must bill the usual and customary dispensing fees for recently fit new hearing aids, replacement hearing aids, ear molds, batteries, supplies, accessories and repaired hearing aids.
- May bill V5299, 1unit, for shipping charges incurred when shipping hearing aids, ear molds, batteries, supplies and accessories to the beneficiary.
- Is not required to submit an invoice for shipping charges with the claim. However, a record of shipping charges must be maintained with the beneficiary’s patient record. The maximum allowed amount is $13.15.
- If the claim is for recently fit new hearing aids and the follow-up visit was not possible within thirty days, record “COVID-19” as the reason on the Post-Evaluation Form and submit the form with the claim.
Provider Assistance
If the original fitting provider is not accessible, and the beneficiary must go through a new provider for replacement hearing aid services, the new provider may obtain the original hearing aid information from NC Medicaid by calling (919) 527-7669.
Author: GDIT, (800) 688-6696