#V5261 HEARING AID MANUALS#
#V5261 HEARING AID CODE#

All goods and services described in Section 1905(a) of the Social Security Act are a covered benefit under EPSDT when medically necessary as defined at 10 C.C.R.The services are a benefit when they meet the following requirements: Other health care services may include other EPSDT benefits if the need for such services is identified. If the OPR NPI on the claim is that of the rendering provider, and the claim does not have modifier 'TL' attached, the claim is subject to recovery.īack to top Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).Any claim with modifier 'TL' attached must be for a service ordered by an approved IFSP and delivered within the time span noted in the IFSP.Early Intervention Audiology claims must have modifier 'TL' attached on the procedure line item for Health First Colorado to identify that the services rendered were associated with an approved IFSP.

Under this circumstance alone the rendering provider must use their own NPI number as the OPR NPI number.

Health First Colorado recognizes that Audiology services ordered in conjunction with an approved IFSP for Early Intervention may not necessarily have an ordering provider.

Claims lacking such documentation on file will be subject to recovery.

Medical documentation must be kept on file to substantiate the order, prescription, or referral for Audiology services.

Claims without a valid OPR NPI number which are paid will then be subject to recovery.

#V5261 HEARING AID CODE#

The term 'valid OPR NPI number' means the registered NPI number of the provider that legitimately orders, prescribes, or refers the Audiology service being rendered, as indicated by the procedure code on the claim.Field 17.b on the CMS1500 claim form must be used for the OPR NPI number.Physicians or other eligible professionals who are already enrolled in Health First Colorado as participating providers and who submit claims to Health First Colorado are not required to enroll separately as OPR providers.The new enrollment requirement for OPR providers does not include a requirement to see Health First Colorado members or to be listed as a Health First Colorado provider for patient assignments or referrals.OPR Providers can begin enrollment on Health First Colorado's website. All physicians, physician assistants, nurse practitioners, or providers associated with an IFSP who order, prescribe, or refer Audiology services for Health First Colorado members must be enrolled in Health First Colorado (42 CFR § 455.410), in accordance with Program Rule 8.125.7.D.Community Centered Boards may have their NPI listed as the referring NPI for IFSP-ordered early intervention services.All Audiology claims must contain the valid NPI number of the OPR physician, physician assistant, nurse practitioner, or provider associated with an Individualized Family Service Plan (IFSP), in accordance with Program Rule 8.125.8.A.Pursuant to the Affordable Care Act's requirements that State Medicaid Agencies ensure correct ordering, prescribing, and referring (OPR) National Provider Identification (NPI) numbers be on the claim form (42 CFR § 455.440):.An approved Individualized Family Service Plan (IFSP) for Early Intervention Audiology services.All Audiology services must have a written order, referral, or prescription by any of the following:.Providers should refer to the Code of Colorado Regulations, Program Rules (-10 8.2.3.D.2), for specific information when providing audiology care.Submit claims for payment to Health First Colorado.Providers must be enrolled as a Health First Colorado provider in order to:

#V5261 HEARING AID MANUALS#

Return to Billing Manuals Web Page Audiology Softbands (including Bone Anchored Hearing Aids - BAHAs).Early and Periodic Screening, Diagnostic, and Treatment (EPSDT).

V5261 hearing aid