Cal. Code Regs. tit. 22 § 51517

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 51517 - Hearing Aids

(a) Reimbursement for hearing aids, hearing aid supplies and accessories, molds or inserts and repairs using the list of Healthcare Common Procedure Coding System codes billable to the Medi-Cal program, shall be the usual charges made to the general public not to exceed the maximum reimbursement rates published in the Medi-Cal Provider Manual, pursuant to Welfare and Institutions Code Section 14105.49.

(b) The following conditions shall apply to the reimbursement for hearing aids, hearing aid supplies and accessories, molds or inserts and repairs under this section.

(1) All hearing aids shall be guaranteed for at least one year exclusive of ear piece, cord and batteries. The guarantee shall cover the repair or replacement of any or all defective parts and labor on a new aid. Out of guarantee repairs shall have a minimum guarantee for at least six months.

(2) Hearing aid maximum allowances listed in this section are for new instruments and include up to six post-sale visits for training, adjustments and fitting, an initial standard package of batteries, a cord, receiver, and such other components normally required for use of the instrument.

(3) Dealer charges for repairs, subsequent to the guarantee period, may be reimbursed. Repair facility reports shall be available for review upon request.

(4) Retail sales tax is reimbursable in addition to the allowances listed in subsection (c). Taxes shall be itemized separately.

(5) Hearing aid provider billings shall include the provider's usual and customary charges for services provided.

(c) The maximum reimbursement rates for hearing aids, hearing aid supplies and accessories, molds or inserts and repairs shall not exceed the lesser of the following:

(1) Hearing Aids

(A) All Monaural hearing aids (one ear only)

1. The maximum allowable amount established by the Department.

2. The one-unit wholesale cost, plus a markup determined by the Department.

3. The billed amount.

4. The rate established by the Department's contracting program to the extent it is in operation.

(B) All Binaural hearing aids (for both ears)

1. The maximum allowable amount established by the Department.

2. The one-unit wholesale cost, plus a markup determined by the Department.

3. The billed amount.

4. The rate established by the Department's contracting program to the extent it is in operation.

(C) CROS/BICROS

1. The maximum allowable amount established by the Department.

2. The one-unit wholesale cost, plus a markup determined by the Department.

3. The billed amount.

4. The rate established by the Department's contracting program to the extent it is in operation.

(2) Hearing Aid Supplies and Accessories

(A) The retail price.

(B) The wholesale cost, plus a markup determined by the Department.

(C) The billed amount.

(D) The rate established by the Department's contracting program to the extent it is in operation.

(3) Molds or Inserts

(A) The maximum amount allowable established by the Department.

(B) The billed amount.

(C) The rate established by the Department's contracting program to the extent it is in operation.

(4) Repairs

The maximum reimbursement for repairs, subsequent to the guarantee period, shall not exceed the lesser of the following:

(A) The invoice cost, plus a markup determined by the Department.

(B) The billed amount.

(C) The rate established by the Department's contracting program to the extent it is in operation.

Cal. Code Regs. Tit. 22, § 51517

1. Certificate of Compliance as to 9-1-82 order transmitted to OAL 12-28-82 and filed 1-21-83 (Register 83, No. 4). For prior history, see Register 82, No. 52.
2. Amendment of subsections (b)(2), (c) and repealer of subsection (d) filed 6-20-83 as an emergency; effective upon filing (Register 83, No. 26). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-18-83.
3. Certificate of Compliance as to 6-20-83 order transmitted to OAL 10-6-83 and filed 11-4-83 (Register 83, No. 45).
4. Editorial correction of NOTE filed 11-4-83 (Register 83, No. 45).
5. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84.
6. Editorial correction of subsection (b)(2) filed 8-30-84 (Register 84, No. 35).
7. Certificate of Compliance as to 8-1-84 order including amendment of subsection (c) transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
8. Amendment of subsection (c) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
9. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
10. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
11. Editorial correction of printing error (Register 93, No. 11).
12. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
13. Amendment of subsection (c), new subsection (d) and amendment of NOTE filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).
14. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).
15. Amendment of subsections (b)(6) and (c) filed 4-4-2003 as an emergency; operative 4-4-2003 (Register 2003, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-4-2003 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 4-4-2003 order transmitted to OAL 7-28-2003 and filed 9-4-2003 (Register 2003, No. 36).
17. Change without regulatory effect amending section and NOTE filed 3-12-2009 pursuant to section 100, title 1, California Code of Regulations, except for amendments of Medi-Cal reimbursement rates and billable codes in subsections (b) and (c), which are exempt from the rulemaking provisions of the Administrative Procedure Act and from the review and approval of the Office of Administrative Law pursuant to Welfare and Institutions Code section 14105.49(b) (Register 2009, No. 11).

Note: Authority cited: Section 20, Health and Safety Code and Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14105 and 14105.49, Welfare and Institutions Code; Statutes of 1982, Chapter 1594, Section 77; Statutes of 1983, Chapter 323, Section 149; Statutes of 1984, Chapter 258, Items 4260-106-001 and 890; Statutes of 1984, Chapter 268, Section 66; Statutes of 1985, Chapter 111, Items 4260-106-001 and 890; and Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.

1. Certificate of Compliance as to 9-1-82 order transmitted to OAL 12-28-82 and filed 1-21-83 (Register 83, No. 4). For prior history, see Register 82, No. 52.
2. Amendment of subsections (b)(2), (c) and repealer of subsection (d) filed 6-20-83 as an emergency; effective upon filing (Register 83, No. 26). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-18-83.
3. Certificate of Compliance as to 6-20-83 order transmitted to OAL 10-6-83 and filed 11-4-83 (Register 83, No. 45).
4. Editorial correction of NOTE filed 11-4-83 (Register 83, No. 45).
5. Amendment of subsection (c) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84.
6. Editorial correction of subsection (b)(2) filed 8-30-84 (Register 84, No. 35).
7. Certificate of Compliance as to 8-1-84 order including amendment of subsection (c) transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
8. Amendment of subsection (c) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
9. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
10. Repealer and new section filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
11. Editorial correction of printing error (Register 93, No. 11).
12. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
13. Amendment of subsection (c), new subsection (d) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52 Items 4260-101-0001 and 0890 (Register 2002, No. 29).
14. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (d), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).
15. Amendment of subsections (b)(6) and (c) filed 4-4-2003 as an emergency; operative 4-4-2003 (Register 2003, No. 14). A Certificate of Compliance must be transmitted to OAL by 8-4-2003 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 4-4-2003 order transmitted to OAL 7-28-2003 and filed 9-4-2003 (Register 2003, No. 36).
17. Change without regulatory effect amending section and Note filed 3-12-2009 pursuant to section 100, title 1, California Code of Regulations, except for amendments of Medi-Cal reimbursement rates and billable codes in subsections (b) and (c), which are exempt from the rulemaking provisions of the Administrative Procedure Act and from the review and approval of the Office of Administrative Law pursuant to Welfare and Institutions Code section 14105.49(b) (Register 2009, No. 11).