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Home > First Nations & Inuit Health > Non-Insured Health Benefits > Health Provider Information > Medical Supplies & Equipment Information > Benefits & Criteria

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1.0 Medical Supplies and Equipment
Audiology Benefits and Criteria

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Portable Document Format(PDF Version - 43 K)

Audiology Benefit Categories

See the Audiology Benefit List for a full list of eligible products, prior approval requirements and frequency limitations.

For information on policies regarding the provision of audiology equipment and supplies, please consult the Provider Guide for Medical Supplies and Equipment.

Audiology Benefit List

List Terminology

Item Description:
Items are listed within general and specific categories (for example: Audiology), in alphabetical order by category and item.
Item Code:
The 8-digit code that must be submitted to ESI Canada for billing purposes.
Prior Approval:
Identifies by general category, or by item within the category, whether prior approval must be obtained by the provider before dispensing the item.

 

1.1 Hearing Aid, Bone Conduction

Hearing Aids, Bone Conduction
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Bone conduction hearing aid, left 99400257 Yes As necessary, minimum of 5 years
Bone conduction hearing aid, right 99400258 Yes As necessary, minimum of 5 years

 

1.2 Hearing Aid, Conventional Analog

Hearing Aids, Conventional Analog
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Behind the ear hearing aid, left 99400247 Yes As necessary, minimum of 5 years
Behind the ear hearing aid, right 99400248 Yes As necessary, minimum of 5 years
Custom hearing aid, left 99400249 Yes As necessary, minimum of 5 years
Custom hearing aid, right 99400250 Yes As necessary, minimum of 5 years

 

1.3 Hearing Aid, CROS/BiCROS

Hearing Aids, Cros/Bicros
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
CROS (specify better hearing ear) 99400255 Yes As necessary, minimum of 5 years
BICROS (specify better hearing ear) 99400256 Yes As necessary, minimum of 5 years

 

1.4 Hearing Aid, Programmable, Analog

Hearing Aids, Programmable, Analog
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Behind the ear hearing aid, left 99400251 Yes As necessary, minimum of 5 years
Behind the ear hearing aid, right 99400252 Yes As necessary, minimum of 5 years
Custom hearing aid, left 99400253 Yes As necessary, minimum of 5 years
Custom hearing aid, right 99400254 Yes As necessary, minimum of 5 years

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1.5 Hearing Aid, Digital Processing

Hearing Aid, Digital Processing
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Digital basic, left 99400522 Yes 5 years
Digital basic, right 99400523 Yes 5 years
Digital custom, left 99400524 Yes 5 years
Digital custom, right 99400525 Yes 5 years

1.6 Hearing Aid Services, Fees, Repairs, and Supplies

Hearing Aid Services, Fees, Repairs, and Supplies
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Assessment/Fitting/
Dispensing Fee, left ear 		99400260 Yes As necessary, minimum of 5 years
Assessment/Fitting/
Dispensing Fee, right ear 		99400261 Yes As necessary, minimum of 5 years
Complete Hearing Assessment (performed bilaterally) - physician prescription - (Complete Hearing Assessment not applicable for clients in B.C.) 99400639 Yes 5 years
BTE ear mold (new aid), left 99400266 Yes 5 years
BTE ear mold (new aid), right 99400267 Yes 5 years
Hearing Aid Performance Check/Readjustment (must be client initiated), left ear 99400640 Yes 1 per year (once the hearing aid warranty has expired)
Hearing Aid Performance Check/Readjustment (must be client initiated), right ear 99400641 Yes 1 per year (once the hearing aid warranty has expired)
Hearing Re-assessment (partial) (performed bilaterally - physician or client initiated) 99400642 Yes 2 years
Hearing Aid Return fee, left 99400264 Yes  
Hearing Aid Return fee, right 99400265 Yes  
Repairs and/or remake by manufacturer, left aid 99400270 Yes outside warranty period
Repairs and/or remake by manufacturer, right aid 99400271 Yes outside warranty period
Repairs out of office, dispenser service fee, left 99400272 Yes  
Repairs out of office dispenser service fee, right ear 99400273 Yes  
In office service fee (includes supplies if necessary), left maximum $20.00 99400274 No 1 per year
In office service fee (includes supplies if necessary), right maximum $20.00 99400275 No 1 per year
Replacement ear mold & impression fee, left, child 99400268 No 1 per year
Replacement ear mold & impression fee, left, adult 99400245 No 1 per 2 years
Replacement ear mold & impression fee, right, child 99400269 No 4 per year
Replacement ear mold & impression fee, right, adult 99400246 No 1 per 2 years

 

1.7 Hearing Aid Supplies Outside Manufacturer Price List

Manufacturer Supplies and Costs on Attached List as per HCCI Agreement; no coding required.

Hearing Aid Supplies Outside Manufacturer Price List
Item Description Item
Code		 Prior Approval Recommended Replacement Guidelines
Accessories/supplies maximum $50.00 99400276 No 1 per 2 years
Batteries, left hearing aid 99400259 No maximum 15 units every 3 months per aid
Batteries, right hearing aid 99400643 No maximum 15 units every 3 months per aid
Tubes/Domes OTE - Left Set of 4 (Max. $20) 99400866 No 1 per year
Tubes/Domes OTE – Right Set of 4 (Max. $20) 99400900 No 1 per year
Date Modified: 2011-01-12

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