2.0 Audiology equipment and supplies benefits list
Effective date: September 27, 2024
The following Medical Supplies and Equipment (MS&E) list contains audiology items and services eligible under the Non-Insured Health Benefits (NIHB) program for eligible First Nations and Inuit. Further you'll find information on coverage policies, item codes, requirements for prior approval and applicable recommended replacement guidelines.
Table of contents
- 2.1 General Information
- 2.2 Hearing Assessments
- 2.3 Hearing Devices
- 2.4 Batteries and Parts
- 2.5 Servicing
2.1 General information
2.1.1 Benefit Policies
General information common to all medical supplies and equipment (MS&E) can be found in the general policies.
2.1.2 Prescriber and provider requirements
Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the specific item as listed in the tables. Items that are prescribed by prescribers/recommenders not recognized by NIHB for the specific item will lead to denials or reversal of claims.
The following is a list of NIHB-recognized prescriber/recommender abbreviations found in this segment of the benefits list. Please refer to the prescriber section of the item tables below to identify the eligible prescriber/recommender of a specific item:
- AUD — Audiologist
- ENT — Otorhinolaryngologist/Otolaryngologist
- HIP* — Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid Dispenser
- MD — Physician
- NP — Nurse Practitioner
The following is a list of NIHB-recognized provider abbreviations found in this segment of the benefits list. Please refer to the provider section of the item tables below to identify the eligible provider of a specific item:
- AUD — Audiologist
- GEN — Enrolled general MS&E and Pharmacy Provider
- HIP — Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid Dispenser
* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador.
2.1.3 Prior Approval Requirements
General prior approval requirements can be found in the general policies
To initiate the prior approval process; complete the Audiology Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website, and submit it to the NIHB regional office along with the following supporting documentation:
- the prescription/recommendation or referral form signed by an NIHB-recognized prescriber for the requested benefit
- the most recent audiometric test or an audiology assessment report which must be less than 6 months old. An audiometric test is not required for the replacement of a cochlear implant (CI) processor
- additional relevant information the provider, physician, nurse practitioner, or audiologist may have to support the request
- an explanation of benefits from any third-party coverage available to the client (for example, provincial plan, workers' compensation board, private insurance, education plans, etc.)
Audiometric tests must be performed by either:
- an Audiologist
- a Hearing Instrument Practitioner* or Audio-prosthetist
* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador.
Repairs require the following information on the prior approval request:
- manufacturer name
- model number or name
- date fitted
- serial number
- description of the problem requiring the repair service
- expiration date of the hearing device warranty
2.1.4 Exclusions
In addition to the general exclusion policy listed in the general policies, the following items are excluded from the audiology benefit and are not considered for coverage or appeal under the NIHB program:
- items used exclusively for education/school (for example, classroom audio distribution systems, also known as sound field systems)
- surgical implants (internal device for CI and bone-anchored hearing system (BAHS))
- hearing protectors used in work-related situations
- therapy treatment (for example, speech therapy)
2.1.5 Warranties
All hearing instruments and/or devices covered under the Hearing Industry Association of Canada (HIAC) agreement must carry, at a minimum, a 2-year warranty and 1-year 'loss and damage replacement' coverage at one occurrence per aid. Children under 18 years old receive, at minimum, a 2-year warranty and a 2-year 'loss and damage replacement' coverage at one occurrence per aid. NIHB clients must be entitled to the same warranties and provisions as all other clients. All items must have a 90-day return privilege at no cost to the client.
For other hearing devices (BAHS processor, CI processor and RM complete systems) the manufacturer's warranty and loss and damage replacement policy apply.
Follow-up:
Aftercare services take place when the original fitting and dispensing fee no longer covers the service provided.
Aftercare services involve:
- adjustment to the client's fitting, including ear mold repairs or replacements
- advice to the client outside a formal appointment, regarding their fitting or their hearing loss which is accommodated by the clinic and/or service provider
2.1.6 Repairs
Repairs are made to restore the hearing device to its original level of performance. A prescription is not needed for repairs; however, prior approval is required for all billable repairs.
Hearing device repairs done under warranty are not subject to service fees.
Repairs that are not covered under the warranty are eligible for coverage when supported by proper documentation.
The following rules apply:
- warranty is expired
- except for hearing aids, a detailed description of all repairs performed with dates and costs must be kept on file for each client
- in the case of hearing aids, repairs must be covered according to the NIHB price
2.1.6.1 Warranty on repairs
All repairs for RM systems, BAHS and CI processors must come with a minimum 6-month warranty.
Hearing aid repair warranty periods must be consistent with the HIAC agreement:
- repairs carried out on a hearing aid during the product purchase warranty period are guaranteed for a maximum of 12 months after repair or until the original product warranty expires, whichever comes first
- all repairs and remakes carried out on a hearing aid after the warranty period expires will be subject to a maximum cost outlined in the pricing grid and will carry a 12-month warranty if the hearing device is less than 5 years old
- charges for repairs and remakes can only be billed after the warranty period, at least 24 months for new aids and 12 months after the repair or remake of an aid
- a remake includes the provision of a new shell for the aid and the replacement of required existing electronic components to ensure that the aid has been returned to the equivalent operating standard of a new aid
2.1.6.2 Repair timeline
- the provider should have at least one permanent business location with the capacity to repair hearing devices and to send devices to manufacturers for repair
- batteries and repair services must be available at the point of service during regular business hours
- a loaner hearing device should be provided free of charge if requested by the client when same-day repairs cannot be completed
- a Behind The Ear (BTE)-type hearing aid is an acceptable loan for In The Ear (ITE) and In The Canal (ITC) hearing aids
- the device should be returned to the client promptly
2.1.7 Replacement requirements
Recommended replacement guidelines indicate the quantity and frequency at which a benefit item will be eligible for coverage. Recommended replacement guidelines are based on a client's customary medical needs and the typical device's lifespan.
All replacement requests require a new prescription.
For more general information, please see section 1.12 Recommended replacement guidelines.
2.1.7.1 Early replacement requirements
Coverage requests for any early replacement require prior approval, a new prescription as well as documentation supporting the need for early replacement. The client must meet program and equipment-specific eligibility criteria.
Early replacement of items may be considered when one of the following has occurred:
- there is a substantial change in a client's medical condition (for example, substantial change in hearing, etc.) and the item no longer meets the client's needs
- the item is no longer functioning properly, has deteriorated during typical use and is no longer under warranty (where the cost of repair exceeds the cost of a new item (except for items covered under an existing repair agreement))
The program will not cover the replacement of lost items (items no longer under loss warranty), stolen items, or items that are damaged due to misuse or negligence.
If requesting early replacement of a hearing aid due to a substantial change in hearing requiring a new device, a copy of the current and previous audiograms must be submitted for review. If the client has not had a substantial change in hearing, specific details regarding the client's unique hearing needs which justify the request for early replacement must be provided. This should include details of the impact of the client's hearing loss on daily living, and how hearing aids will improve their situation.
For items eligible for a trade-in allowance such as a cochlear implant processor, the trade-in value must be submitted with the prior approval request.
2.1.8 Services included in the NIHB price
Following a maximum 90 day trial, clients may request the following services to be provided at no additional charge:
- appropriate reinforcement of information, instructions, and retraining on the device
- any modifications to improve the comfort of the device
- any modifications to the electroacoustic characteristics of the device based upon reactions and experiences of the client
- any adjustments or changes to amplification levels due to client reactions to enhance client benefit from the device
- other further adjustments
2.1.9 Terminology
Item code
The item code is an 8-digit code that identifies the benefit being requested and is submitted to Express Scripts Canada for billing purposes.
Prior approval
A program coverage confirmation is issued by an NIHB regional office to a provider to ensure that the client is eligible for specific medical supplies and equipment benefits. The approval is issued primarily for items identified as requiring prior approval before being billed to the program. All claims, including claims accompanied by prior approvals, are subject to claim verification.
Recommended replacement guidelines
The recommended replacement guidelines set a maximum number of each item a client may receive over a given period (frequency). Coverage of additional items may be considered on a case-by-case basis. For requests exceeding the recommended replacement guidelines, prior approval is required.
NIHB price
NIHB price information is listed in the MS&E price files, located on the Express Scripts Canada NIHB provider and client website.
When an NIHB price is established for an item, it must not be claimed by default. To be eligible for payment, providers must adhere to the NIHB program's terms and conditions set out in their MS&E provider billing agreement and submit eligible claim amounts in accordance to the MS&E Claims Submission Kit and reimbursement policies.
2.2 Hearing assessments
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400639 | Complete hearing assessment | MD, NP, AUD, HIP | AUD, HIP | No | 1 every 5 years | To be used for all clients (pediatric and adult) |
| 99400642 | Hearing reassessment | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 2 years | To be used for all clients 18 years and older or any client under 18 that does not have a hearing aid, CI, BAHS etc. |
| 99401244 | Hearing reassessment pediatric initial (first hearing aid, CI, etc.) | MD, NP, AUD | AUD | Yes | 6 in first 2 years ( 4 in year 1 and 2 in year 2) | Code to be used for hearing tests conducted for pediatric populations (under 18) who are fit with amplification such as hearing aids, CI, bone anchored hearing system, etc. to monitor audiological status during the first 2 years after fitting. There should typically be a minimum of 3 months between each reassessment. After 2 years use code 99401245 as applicable |
| 99401245 | Hearing reassessment pediatric annual | MD, NP, AUD | AUD | Yes | 1 per year | To be used after expiration of code 99401244 for clients under 18 years who have a hearing aid, CI, etc. |
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.3 Hearing devices
2.3.1 Hearing aids
The NIHB program covers an approved list of hearing aids. Providers must inform their clients that the program may not cover or reimburse requests for hearing aids that are not on the approved list.
2.3.1.1 Hearing aids criteria for children (under 18)
- clients are eligible for coverage if there is a hearing loss of 25 dB or greater at any frequency from 500 to 4000 Hz
2.3.1.2 Hearing aids criteria for adults
- clients are eligible for coverage if there is a total hearing loss of 100 dB or more (total of the thresholds at 500 Hz, 1000 Hz, 2000 Hz and 3000 Hz) or high-frequency hearing loss of 40 dB or more at 2 frequencies from 3000 to 6000 Hz.
- providers should perform a needs assessment using a standardized tool which includes client motivation to use a hearing device (for example, total or screening versions of the Hearing Handicap Inventory, the Client Oriented Scale of Improvement (COSI), etc.). The needs assessment must be kept in the client's file and must be provided upon request for verification purposes.
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401255 | Completely in canal or invisible in canal, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99401256 | Completely in canal or invisible in canal, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400256 | Hearing aid BiCROS | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400257 | Hearing aid bone conduction, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400258 | Hearing aid bone conduction, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400255 | Hearing aid CROS | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400522 | Behind-the-Ear hearing aid, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400523 | Behind-the-Ear hearing aid, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400524 | Hearing aid digital custom, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| 99400525 | Hearing aid digital custom, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | |
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.3.2 Bone Anchored Hearing System (BAHS) processor
Audiologists prescribing or providing BAHS must work in a facility with a dedicated BAHS program or have training with BAHS and experience with clients having BAHS.
2.3.2.1 Eligibility criteria (initial)
- the client has conductive/mixed hearing loss that cannot be treated medically and for whom an air conduction hearing aid is contraindicated (decision should be made by an audiologist and ENT physician)
- the prescriber has identified the client as one who would benefit from BAHS
- the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program
2.3.2.2 Eligibility criteria (replacement)
- the BAHS processor currently in use is either:
- 5 years old or older (from the original fitting date)
- not working (and is no longer under warranty) and the cost of repair exceeds the cost of a new processor
2.3.2.3 Softband
2.3.2.3.1 Eligibility criteria (initial and replacement)
- the client is too young (generally under 5 years) for a BAHS implant
- when recommended by an audiologist for clients that cannot have an implant
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401229 | Hearing aid processor bone anchored, left | AUD, ENT | AUD | Yes | 1 every 5 years | |
| 99401228 | Hearing aid processor bone anchored, right | AUD, ENT | AUD | Yes | 1 every 5 years | |
| 99400947 | Parts for bone anchored hearing system | AUD | AUD | Yes | ||
| 99401230 | Softband | AUD, ENT | AUD | Yes | 1 per year | Client cannot have an implant usually due to age (under 5) |
2.3.3 Cochlear implant (CI) processor
Audiologists prescribing or providing CIs must work in a facility with a dedicated CI program or have training with CIs and experience with clients having CIs.
2.3.3.1 Eligibility criteria (initial), children (under 18)
- severe-to-profound sensorineural hearing loss bilaterally
- receive little or no benefit from hearing aids
- the prescriber has identified the client as one who would benefit from CI
- the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program
2.3.3.2 Eligibility criteria (initial), adults
- moderate to severe/profound sensorineural hearing loss
- limited benefit from optimally fitted amplification
- the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program
2.3.3.3 Eligibility criteria (replacement), all ages
- the CI processor currently in use is either:
- 5 years old or older (from the original fitting date)
- not working (and is no longer under warranty) and the cost of repair exceeds the cost of a new processor
Note: An audiometric test is not required for the replacement of a CI processor
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401227 | Cochlear implant processor, left | AUD, ENT | AUD | Yes | 1 every 5 years | |
| 99401226 | Cochlear implant processor, right | AUD, ENT | AUD | Yes | 1 every 5 years | |
| 99400948 | Parts for cochlear implant processor | AUD | AUD | Yes |
2.3.4 Remote Microphone (RM) complete system
To be eligible for an RM-complete system, the client must have at least ONE of the following:
- the client has a unilateral or bilateral permanent hearing loss and has a justified need for an RM-complete system
- the client has normal hearing and has a need to improve functional auditory capacity that cannot be met with standard amplification
- the client has been diagnosed with auditory neuropathy
For adult clients, justification should include supporting evidence that the client engages in daily activities such as attending meetings, classes, or group activities, where hearing aids or accessory-level remote microphones do not meet their needs. Justification should also address client motivation (for example, submit a copy of the formal needs assessment).
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400955 | RM–complete system | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 5 years | RM-complete system may include a receiver, transmitter and all other accessories required for proper use and functioning (for example, audio shoes, charger, lanyard etc.) |
| 99400962 | RM-complete system fitting fee | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 5 years | |
| 99401360 | RM-complete system fitting fee - tele-audiology | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 5 years | For clients living in remote areas; only 1 fee, either in-person or by tele-audiology, can be claimed once every 5 years. |
| 99400960 | Accessories for RM-complete system | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 5 years | |
| 99400956 | Audio shoe RM-complete system, left | MD, NP, AUD, HIP | AUD, HIP | Yes | 1 every 5 years | |
| 99400957 | Audio shoe RM-complete system, right | MD, NP, AUD, HIP | AUD HIP | Yes | 1 every 5 years | |
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.3.5 Non-implantable bone conduction hearing system
To be eligible for a non-implantable bone conduction hearing system, the client must have ONE of the following:
- the client has a bilateral or unilateral conductive hearing loss that cannot be addressed by conventional hearing aids. The client must have excellent bone conduction thresholds (5 to -5 dB) in the aided ear or ears
- examples include atresia or recurrent otitis media with effusion
OR
- the client has single-sided sensorineural hearing loss and a trial with a CROS hearing aid was attempted with no success
OR
- the client is a candidate for surgical implantation who has not met the age requirement, a candidate for whom surgery is contra-indicated, or a candidate who is unwilling to undergo surgery
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401273 | Adhesive adapter, left | AUD, MD, NP, HIP | AUD, HIP | Yes | 5 packages per year | The package contains 15 adhesive adapters |
| 99401274 | Adhesive adapter, right | AUD, MD, NP, HIP | AUD, HIP | Yes | 5 packages per year | The package contains 15 adhesive adapters |
| 99401242 | Adhesive wipes | AUD, HIP | AUD, HIP | No | 3 boxes per year | |
| 99401276 | Cable, bone conduction hearing system | AUD, MD, NP, HIP | AUD, HIP | Yes | 1 every 2 years | |
| 99401271 | Non-implantable bone conduction hearing system, left | AUD, MD, NP, HIP | AUD, HIP | Yes | 1 every 5 years | Each new processor unit comes with 5 packages of adhesive adapters and an accessory box that includes:
|
| 99401272 | Non-implantable bone conduction hearing system, right | AUD, MD, NP, HIP | AUD, HIP | Yes | 1 every 5 years | Each new processor unit comes with 5 packages of adhesive adapters and an accessory box that includes:
|
| 99401275 | Sound check tool, bone conduction hearing system | AUD, MD, NP, HIP | AUD, HIP | Yes | 1 every 5 years | |
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.4 Batteries and parts
2.4.1 Batteries
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400259 | Batteries hearing aid, left | GEN, AUD, HIP | No | 24 every 144 days | ||
| 99400643 | Batteries hearing aid, right | GEN, AUD, HIP | No | 24 every 144 days | ||
| 99401316 | Batteries, non-implantable bone conduction, left | GEN, AUD, HIP | Yes | 32 every 90 days | ||
| 99401317 | Batteries, non-implantable bone conduction, right | GEN, AUD, HIP | Yes | 32 every 90 days | ||
| 99400970 | Disposable battery BAHS processor, left | GEN, AUD, HIP | No | 3 per week | ||
| 99400971 | Disposable battery BAHS processor, right | GEN, AUD, HIP | No | 3 per week | ||
| 99400968 | Disposable battery cochlear implant, left | GEN, AUD, HIP | No | 7 per week | ||
| 99400969 | Disposable battery cochlear implant, right | GEN, AUD, HIP | No | 7 per week | ||
| 99401252 | Rechargeable battery charger CI processor | GEN, AUD, HIP | No | 1 every 5 years | ||
| 99401251 | Rechargeable battery CI processor, left | GEN, AUD, HIP | No | 1 per year | For each battery type, providers are required to bill according to the manufacturer price indicated in the MS&E price files, which can be found on the Express Scripts Canada NIHB provider and client website. | |
| 99401250 | Rechargeable battery CI processor, right | GEN, AUD, HIP | No | 1 per year | For each battery type, providers are required to bill according to the manufacturer price indicated in the MS&E price files, which can be found on the Express Scripts Canada NIHB provider and client website. | |
| 99401248 | Rechargeable battery hearing aid, left | GEN, AUD, HIP | No | 1 every 3 years | ||
| 99401247 | Rechargeable battery hearing aid, right | GEN, AUD, HIP | No | 1 every 3 years |
2.4.2 Parts (including accessories and supplies)
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400276 | Accessories for hearing aids | AUD, HIP | AUD, HIP | No | 1 every 5 years | This code can only be used once every 5 years and can include more than one accessory, up to the NIHB price listed in the MS&E price files, which can be found on the Express Scripts Canada NIHB provider and client website. If more than one accessory, all must be included on one reimbursement form. Providers should retain product information for warranty purposes. Accessories include items that work in conjunction with hearing aids to increase functionality and/or help in the maintenance and may include but are not limited to remote controls, audio streamers, microphones, dry aid kits, etc. Rechargeable hearing aids typically come with a charger at no cost therefore the accessories code must not be used for a hearing aid charger. |
| 99400266 | Ear mold new, left | AUD, HIP | AUD, HIP | Yes | 1 every 5 years | |
| 99400267 | Ear mold new, right | AUD, HIP | AUD, HIP | Yes | 1 every 5 years | |
| 99400245 | Replacement ear mold & impression fee, adult, left | AUD, HIP | No | 1 every 2 years | The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for a new ear mold is included in the fitting and dispensing fee for hearing aids | |
| 99401326 | Receiver tube, replacement, left | AUD, HIP | AUD, HIP | No | 3 every 5 years | Receiver tube replacement is covered under the hearing aid warranty in the first 2 years. This code should only be used when the hearing aid is no longer under warranty. Claims submitted that do not meet this criteria are subject to reversal. |
| 99401327 | Receiver tube, replacement, right | AUD, HIP | AUD, HIP | No | 3 every 5 years | Receiver tube replacement is covered under the hearing aid warranty in the first 2 years. This code should only be used when the hearing aid is no longer under warranty. Claims submitted that do not meet this criteria are subject to reversal. |
| 99400246 | Replacement ear mold & impression fee, adult, right | AUD, HIP | No | 1 every 2 years | The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for a new ear mold is included in the fitting and dispensing fee for hearing aids | |
| 99400268 | Replacement ear mold & impression fee, child, left | AUD, HIP | No | 4 per year | The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for a new ear mold is included in the fitting and dispensing fee for hearing aids | |
| 99400269 | Replacement ear mold & impression fee, child, right | AUD, HIP | No | 4 per year | The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for a new ear mold is included in the fitting and dispensing fee for hearing aids | |
| 99400866 | Tubes/domes over the ear, left | AUD, HIP | AUD, HIP | No | 1 pack of 4 per year | Outside warranty period |
| 99400900 | Tubes/domes over the ear, right | AUD, HIP | AUD, HIP | No | 1 pack of 4 per year | Outside warranty period |
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.5 Servicing
2.5.1 Fees
| Item code | Item name | Prescriber* | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401225 | Fitting and dispensing fee, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | Code for fitting and dispensing hearing aid, CI or BAHS by the provider while the hearing device is still under the manufacturer's warranty (for example, adjusting the hearing aid and counselling the client) |
| 99401224 | Fitting and dispensing fee, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | Code for fitting and dispensing hearing aid, CI or BAHS by the provider while the hearing device is still under the manufacturer's warranty (for example, adjusting the hearing aid and counselling the client) |
| 99401356 | Fitting and dispensing fee - tele-audiology, left | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | Code for fitting and dispensing hearing aid by tele-audiology while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counselling the client). For clients living in remote areas; only 1 fee, either in-person or by tele-audiology, can be claimed once every 5 years. |
| 99401357 | Fitting and dispensing fee - tele-audiology, right | AUD, HIP, MD, NP | AUD, HIP | Yes | 1 every 5 years | Code for fitting and dispensing hearing aid by tele-audiology while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counselling the client). For clients living in remote areas; only 1 fee, either in-person or by tele-audiology, can be claimed once every 5 years. |
| 99400640 | Hearing aid performance check and readjustment fee, left | AUD, HIP | AUD, HIP | Yes | 1 per year | Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device (for example, electroacoustic evaluation, Real Ear Measures (REM), listening check, client interview) and making necessary adjustments to the device through programming, ear mold modification, etc. Must be client initiated |
| 99400641 | Hearing aid performance check and readjustment fee, right | AUD, HIP | AUD, HIP | Yes | 1 per year | Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device (for example, electroacoustic evaluation, Real Ear Measures (REM), listening check, client interview) and making necessary adjustments to the device through programming, ear mold modification, etc. Must be client initiated |
| 99401358 | Hearing aid performance check and readjustment fee, tele-audiology, left | AUD, HIP | AUD, HIP | Yes | 1 per year | Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device by tele-audiology. Must be client-initiated |
| 99401359 | Hearing aid performance check and readjustment fee, tele-audiology, right | AUD, HIP | AUD, HIP | Yes | 1 per year | Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device by tele-audiology. Must be client-initiated |
| 99400274 | In office service fee, left | AUD, HIP | No | Service code for minor repairs to hearing aids in the office (for example, replacing the tubing on Behind The Ear (BTE) ear molds, replacing worn or malfunctioning parts, etc.) Includes supply if necessary. | ||
| 99400275 | In office service fee, right | AUD, HIP | No | Service code for minor repairs to hearing aids in the office (for example, replacing the tubing on Behind The Ear (BTE) ear molds, replacing worn or malfunctioning parts, etc.) Includes supply if necessary. | ||
| 99400272 | Repairs out of office dispenser service fee, left | AUD, HIP | Yes | Service code for any work/service carried out by the provider when the hearing device is sent to the manufacturer for repair. This code should only be used when the hearing aid is no longer under warranty. | ||
| 99400273 | Repairs out of office dispenser service fee, right | AUD, HIP | Yes | Service code for any work/service carried out by the provider when the hearing device is sent to the manufacturer for repair. This code should only be used when the hearing aid is no longer under warranty. | ||
| 99400264 | Return fee hearing aid, left | AUD, HIP | Yes | Code for the provider to bill for professional time when hearing aids are returned during the trial period only. The provider must cancel the prior approval for the hearing aids, the fit and dispense fee when hearing aids are returned, as well as contact Express Scripts Canada, to reverse the claim (see section 5.8. MS&E Claims Reversal, of the MS&E Claims Submission Kit, which can be found on the Express Scripts Canada NIHB provider and client website). | ||
| 99400265 | Return fee hearing aid, right | AUD, HIP | Yes | Code for the provider to bill for professional time when hearing aids are returned during the trial period only. The provider must cancel the prior approval for the hearing aids, the fit and dispense fee when hearing aids are returned, as well as contact Express Scripts Canada, to reverse the claim (see section 5.8. MS&E Claims Reversal, of the MS&E Claims Submission Kit, which can be found on the Express Scripts Canada NIHB provider and client website). | ||
| * NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Newfoundland and Labrador. | ||||||
2.5.2 Repairs and remake
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401371 | Remake only, left | AUD, HIP | Yes | For hearing aids out of warranty only | ||
| 99401372 | Remake only, right | AUD, HIP | Yes | For hearing aids out of warranty only | ||
| 99401122 | Remake with repair by manufacturer, left | AUD, HIP | Yes | Outside warranty period | ||
| 99401123 | Remake with repair by manufacturer, right | AUD, HIP | Yes | Outside warranty period | ||
| 99400966 | Repair, BAHS processor, left | AUD | Yes | |||
| 99400967 | Repair, BAHS processor, right | AUD | Yes | |||
| 99400964 | Repair, cochlear implant processor, left | AUD | Yes | |||
| 99400965 | Repair, cochlear implant processor, right | AUD | Yes | |||
| 99400963 | Repair, RM systems | AUD | Yes | |||
| 99400270 | Repair, hearing aid manufacturer, left | AUD, HIP | Yes | Outside warranty period | ||
| 99400271 | Repair, hearing aid manufacturer, right | AUD, HIP | Yes | Outside warranty period | ||
| 99401277 | Repair, non-implantable bone conduction hearing system, left | Yes | ||||
| 99401278 | Repair, non-implantable bone conduction hearing system, right | Yes |
2.5.3 Delivery, shipping and handling
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400961 | Shipping and handling, RM-complete system | AUD, HIP | No | 1 per client order | Charge from the manufacturer to the provider for shipping and handling of the RM-complete system | |
| 99401260 | Delivery, audiology | AUD, HIP | Yes | Delivery of equipment to the client | ||
| 99401096 | Shipping and handling, hearing aids and accessories | AUD, HIP | No | 1 per client order | Charge from the manufacturer to the provider for shipping and handling of hearing aids and accessories |