Rates for Hearing Services

Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

101 CMR 323.00: RATES FOR HEARING SERVICES

Section

323.01: General Provisions 323.02: Definitions 323.03: General Rate Provisions, Requirements, and Rates 323.04: Reporting Requirements 323.05: Severability

323.01: General Provisions

(1) Scope and Purpose. .00 governs the payment rates to be used by all governmental units and purchasers under M.G.L. c. 152 (the Workers’ Compensation Act) for hearing services provided to publicly aided individuals and industrial accident patients.

(2) Applicable Dates of Service. Rates contained in .00 apply for dates of service on or after December 1, 2025.

(3) Disclaimer of Authorization of Services. .00 is not authorization for or approval of the procedures for which rates are determined pursuant to .00. Governmental units and purchasers under M.G.L. c. 152 that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals and industrial accident patients.

(4) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of .00 and to update billing codes in accordance with .01(5).

(5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. Updates may reference coding systems including, but not limited to, the American Medical Association’s Current Procedural Terminology® (CPT) and Healthcare Common Procedure Coding System (HCPCS). The publication of such updates and corrections will list (a) codes for which the code numbers change, with the corresponding cross-references between new codes and codes being replaced. Rates for such new codes are set at the rate of the code that is being replaced; (b) codes for which the code number remains the same, but the description has changed; (c) deleted codes for which there are no corresponding new codes; and (d) codes for entirely new services that require pricing. EOHHS will list these codes and apply individual consideration (IC) payment for these codes until appropriate rates can be developed.

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

323.02: Definitions

As used in .00, unless the context requires otherwise, terms have the meanings in .02.

Accessories. Those essential items or options on a hearing aid purchased by a hearing instrument specialist that are not intrinsic components of the basic hearing aid unit. Accessories do not include nonessential items such as carrying cases.

Adjusted Acquisition Cost (AAC). The actual unit price paid to a manufacturer by a hearing aid dispenser for a hearing aid or accessories, including costs for shipping and handling, and excluding postal insurance charges.

Assessment of Hearing Aid. A procedure that includes (a) assessment of a patient's performance by appropriate tests with hearing aid devices; (b) a recheck of the patient and hearing aid after the prescribed aid has been fitted and used for a trial period; and (c) counseling related to the patient's adjustment to the use of the hearing aid.

Audiological Evaluation. A routine audiological evaluation that includes (a) pure tone audiogram, by air and bone conduction testing; and (b) speech reception and discrimination testing.

Aural Rehabilitation. Therapy provided by a qualified audiologist either in a group or individually including, but not limited to: (a) Lip-reading. Training of the visual modality to improve the understanding of the speech or language of other speakers. (b) Auditory Training. Training of the auditory modality to improve the understanding of the speech or language of other speakers.

Binaural. The type of fitting or aid necessitated by varying degrees of hearing loss in both ears that requires unparalleled amplification via the use of two microphones and/or receivers.

Binaural Fitting. The fitting of two hearing aids, one to each ear, by a provider; the fitting to the second ear taking place no later than six months after the fitting to the first ear.

Contralateral Routing Hearing Aid. A type of hearing aid configuration that routes sounds from the hearing-impaired ear to the hearing ear via the use of a microphone.

Electroacoustic Evaluation for Hearing Aid. A check of the patient's personal hearing aid (includes electroacoustical analysis of the aid).

EOHHS. The Executive Office of Health and Human Services established under M.G.L. c. 6A.

Governmental Unit. The Commonwealth, any department, agency, board, division, or commission of the Commonwealth, and any political subdivision of the Commonwealth.

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

Hearing Aid. A small electronic device consisting of a microphone, an amplifier, and a receiver.

Hearing Aid Check. A check of the functioning of the patient's monaural or binaural hearing aid.

Hearing Services. Services including testing related to the determination of hearing loss, evaluation of hearing aids, the prescription of hearing aid devices, and aural rehabilitation.

Individual Consideration (IC). A designation indicating that there is no specified rate for a given service. Payment amounts for services designated “IC” are determined by the governmental unit purchasing such services. The governmental unit determines the appropriate payment based on the provider’s report of services provided and documentation as requested by the governmental unit. The report must include a pertinent history and diagnosis, a description of the service rendered, and the length of time spent with the patient. In making the determination of the appropriate payment amount, the governmental unit uses the following criteria: (a) the policies, procedures, and practices of other third-party purchasers of care, both governmental and private; (b) the severity and complexity of the patient's disorder or disability; (c) prevailing provider ethics and accepted practice; and (d) the time, degree of skill, and cost including equipment cost required to perform the procedure(s).

Industrial Accident Patient. A person who receives medical services for which persons, corporations, or other entities are in whole or part liable under M.G.L. c. 152 (the Workers’ Compensation Act).

Major Repairs. Repairs to a hearing aid that must be made by a repair facility other than the provider's place of business.

Minor Repairs. Repairs performed at the provider's place of business such as, but not limited to, replacement and cleaning of tubing.

Monaural Fitting. The fitting of one hearing aid by a provider.

Nonorganic Test Battery. Tests done to determine functional hearing loss.

Out-of-office Rates. Providers must use the appropriate place of service (POS) code when billing for out-of-office services. Out-of-office rates are 115% of their respective in-office counterparts.

Out-of-office Services. Authorized services provided in a nursing home, school, patient’s home, or any other setting where the provider travels from his or her usual place of business to provide the service. Out-of-office services include only the codes in the following sections. .03(5)(b)1.: Hearing Aid Dispensing Fees .03(5)(c): Maximum Fees for Earmolds .03(5)(d): Maximum Fee for Ear Impressions .03(5)(e): Maximum Fees for Batteries .03(5)(i): Maximum Fee for Minor Repairs .03(5)(j): Maximum Fee for Major Repairs

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

Place of Service (POS). Providers who file claims with the MassHealth agency must use the following CMS POS codes. 03 – School 04 – Homeless shelter 11 – Office 12 – Home 19 – Off campus—outpatient hospital 22 – On campus—outpatient hospital 26 – Military treatment facility 31 – Skilled nursing facility 32 – Nursing facility 99 – Other place of service

Provider. A provider acting within the scope of the provider’s license, in accordance with all applicable state and federal laws, who meets such conditions of participation as have been adopted by governmental units purchasing audiological services or by purchasers under M.G.L. c. 152 (the Workers’ Compensation Act), and who is one of the following: (a) an audiologist who is currently licensed by the Massachusetts Board of Registration in Speech-language Pathology and Audiology; (b) any speech and hearing center (proprietorship, partnership, or corporation) that is not part of a hospital and provides authorized speech, hearing, or language services provided by a licensed, certified audiologist or a certified speech and language pathologist and does not bill separately from such facility for professional services; (c) an audiology assistant who is currently licensed by the Massachusetts Board of Registration in Speech-language Pathology and Audiology; or (d) a hearing instrument specialist who is currently licensed by the Massachusetts Board of Registration of Hearing Instrument Specialists.

Publicly Aided Individual. A person who receives health care and other services for which a governmental unit is in whole or in part liable under a statutory program of public assistance.

Used Hearing Aid. Any hearing aid that has been worn for any period of time by a user.

323.03: General Rate Provisions, Requirements, and Rates

(1) General Rate Provisions. Payment for the purchase of hearing aids and authorized related accessories and services for the care and maintenance of hearing aid instruments are the lowest of (a) the provider's usual charge to persons other than publicly aided individuals and industrial accident patients; (b) the provider's actual charge submitted; or (c) the schedule or maximum fees listed in .03(5).

(2) Reimbursement as Full Payment. The payment rates under .03 are full compensation for care rendered to publicly aided individuals and industrial accident patients, as well as for any related administrative or supervisory duties and costs in connection with the services provided. Each provider must, as a condition of acceptance of payment made by the

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

governmental unit purchasing audiological services or purchaser under M.G.L. c. 152 (the Workers’ Compensation Act), accept the rate as full payment and discharge of all obligations for the services rendered.

(3) General Requirements and Services Included. (a) Purchase of Hearing Aids. Payment for a hearing aid includes 1. the hearing aid and standard accessories for the proper operation of the hearing aid and proper fitting and instruction in the use, care, and maintenance of the hearing aid; and minor repairs and services as usually provided non–publicly aided individuals and industrial accident patients that may be necessary during the operational life of the hearing aid; 2. a mandatory one-year manufacturer's warranty and/or insurance against loss or damage; and 3. the cost of a loaner hearing aid when necessary. (b) Earmold. Payment for an earmold includes the proper fitting of the earmold on delivery, and adjustments as may be needed. The maximum fee stipulated in .03(5)(c) is not allowed if an earmold is included in the manufacturer's price of the aid or the client already has an earmold. (c) Ear Impression. Payment for an ear impression includes one properly formed ear impression for each in-the-ear (ITE), in-the-canal (ITC), and behind-the-ear (BTE) aid purchased. The fee stipulated in .03(5)(d) is allowed only at the time an aid is purchased. The fee listed in .03(5)(d) includes provision for all associated costs. (d) Batteries. Proper freshness of batteries must be ensured. The maximum fee listed in .03(5)(e) includes provision for all associated costs. Batteries must be new and unused at the time of purchase. (e) Other Accessories or Options for a Hearing Aid. Proper fitting and adjustment of the accessory must be provided as needed. The maximum fee listed in .03(5)(g) includes provision for all associated costs. Accessories must be new and unused at the time of purchase. (f) Refitting Services/Other Professional Services. Additional fitting/refitting services are reimbursed only if the hearing aid was dispensed more than one year prior to the date of service of the refitting services. These professional services include refitting of the aid, orientation, counseling the member or member’s family, contact with interpreters, fitting of a loaner aid, and similar services. Reimbursement for such services must include a face-to-face encounter with the publicly aided individual or industrial accident patient. (g) Minor Repairs and Office Visits for Evaluation and Management Services. An office visit for evaluation and management services is reimbursed only when one or more of the following services is required and is provided as part of the visit: 1. minor adjustments to the hearing aid to ensure a proper fitting, such as an earmold adjustment, when a provider is not the provider who initially fit the hearing aid, and the provider who initially fit the hearing aid no longer provides services to publicly aided individuals or industrial accident patients; 2. minor office repairs for which the provider customarily charges patients who are neither publicly aided individuals nor industrial accident patients; 3. cleaning of the hearing aid; or

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

4. replacement of parts such as, but not limited to, tubing, hooks, battery doors, and replacement. No fee is allowed when the provider does not customarily charge clients other than publicly aided individuals and industrial accident patients for these repairs. (h) Major Repairs. A provider may submit a bill for major repairs to a hearing aid only after all warranties and/or insurance have expired. The hearing aid in need of a major repair must be sent directly to the repair facility or manufacturer that will perform the repair. Handling charges by an intermediary may not be submitted. Repair services must include a written warranty against all defects for a minimum of six months unless otherwise documented by the repair facility or manufacturer. The provider of the repair services is responsible for the quality of the workmanship and parts, and for ensuring that the repaired aid is in proper working condition. The maximum fee listed in .03(5)(j) includes provision for all associated costs. (i) Extended Insurance Covering Loss and Damage. The manufacturer's insurance policy must provide coverage for the loss or damage of a hearing aid for no less than one year and up to three years following purchase. (j) Other Services. No payment is allowed when the provider does not customarily charge clients other than publicly aided individuals and industrial accident patients for such items.

(4) Two Audiologists. The MassHealth agency pays for two audiologists working together to perform an evaluation of an individual member when the knowledge, skills, and experience of the primary audiologist have identified a need for a second audiologist to aid in completing the initial test battery, such as for the testing of very young children or those with other pertinent developmental, physical, cognitive, or maturational factors. Circumstances warranting the services of two audiologists must be fully documented in the member’s medical record. To receive full payment, both audiologists must use the appropriate service code and modifier combination listed in Subchapter 6 of the MassHealth Audiologist Manual. The MassHealth agency will pay 1/2 of the total allowable payment for two audiologists to each individual provider.

(5) Rates. .03(5) sets forth maximum fees for the items and services listed in 101 CMR 323.03(5). (a) Maximum Fees for Audiological Services. 1. Vestibular Function Tests, with Recording and Medical Diagnostic Evaluation.

Code Description Rate Spontaneous nystagmus test, including gaze and fixation 92541 $52.21 nystagmus, with recording Positional nystagmus test, minimum of four positions, with 92542 $53.86 recording Optokinetic nystagmus test, bidirectional, foveal or peripheral 92544 $43.19 stimulation, with recording 92545 Oscillating tracking test, with recording $39.30 92546 Sinusoidal vertical axis rotational testing $81.48 Use of vertical electrodes (List separately in addition to code 92547 $24.52 for primary procedure)

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

2. Audiologic Function Tests with Medical Diagnostic Evaluation.

Code Description Rate 92551 Screening test, pure tone, air only $9.49 92552 Pure tone audiometry (threshold); air only $18.37 92553 Pure tone audiometry (threshold); air and bone $26.26 92555 Speech audiometry threshold $15.05 92556 Speech audiometry threshold; with speech recognition $22.20 Comprehensive audiometry threshold evaluation and speech 92557 $49.51 recognition (92553 and 92556 combined) 92562 Loudness balance test, alternate binaural or monaural $18.73 92563 Tone decay test $16.17 92565 Stenger test, pure tone $14.31 92567 Tympanometry (impedance testing) $20.36 92568 Acoustic reflex testing, threshold $14.26 92572 Staggered spondaic word test $8.39 92576 Synthetic sentence identification test $18.61 92577 Stenger test, speech $23.91 92579 Visual reinforcement audiometry (VRA) $29.59 92582 Conditioning play audiometry $31.82 92583 Select picture audiometry $33.04 92584 Electrocochleography $84.33 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing 92587 $56.57 disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of 92588 $79.19 outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report 92590 Hearing aid examination and selection; monaural $24.23 92591 Hearing aid examination and selection; binaural $35.94 92592 Hearing aid check; monaural $15.19 92593 Hearing aid check; binaural $30.38 92594 Electroacoustic evaluation for hearing aid; monaural $41.64 92595 Electroacoustic evaluation for hearing aid; binaural $83.32 92596 Ear protector attenuation measurements $26.62 Auditory evoked potentials; screening of auditory potential 92650 $67.81 with broadband stimuli, automated analysis Auditory evoked potentials; for hearing status determination, 92651 $67.81 broadband stimuli, with interpretation and report Auditory evoked potentials; for threshold estimation at 92652 $94.37 multiple frequencies, with interpretation and report Auditory evoked potentials; neurodiagnostic, with 92653 $94.37 interpretation and report V5020 Conformity evaluation $90.94

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

3. Evaluative and Therapeutic Services.

Code Description Rate Vestibular evoked myogenic potential (VEMP) testing, with 92517 IC interpretation and report; cervical (cVEMP) Vestibular evoked myogenic potential (VEMP) testing, with 92518 IC interpretation and report; ocular (oVEMP) Vestibular evoked myogenic potential (VEMP) testing, with 92519 interpretation and report; cervical (cVEMP) and ocular IC (oVEMP) Diagnostic analysis of cochlear implant, patient younger than 92601 $143.78 7 years old; with programming Diagnostic analysis of cochlear implant, patient younger than 92602 7 years old; subsequent reprogramming (do not report 92602 $98.64 in addition to 92601) Diagnostic analysis of cochlear implant, 7 years of age or 92603 $90.51 older; with programming Diagnostic analysis of cochlear implant, 7 years of age or 92604 older; subsequent reprogramming (do not report 92604 in $58.69 addition to 92603) Evaluation of central auditory function, with report; initial 60 92620 $59.45 minutes Evaluation of central auditory function, with report; each 92621 additional 15 minutes (List separately in addition to code for $14.87 primary procedure) Diagnostic analysis, programming, and verification of an 92622 auditory osseointegrated sound processor, any type; first 60 $48.08 minutes Diagnostic analysis, programming, and verification of an 92623 auditory osseointegrated sound processor, any type; each $12.37 additional 15 minutes Evaluation of auditory function for surgically implanted 92626 device(s) candidacy or postoperative status of a surgically $59.45 implanted device(s); first hour Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically 92627 $14.87 implanted device(s); each additional 15 minutes (List separately in addition to code for primary procedure) 92700 Unlisted otorhinolaryngologic service or procedure IC

4. Miscellaneous.

Code Description Rate V5008 Hearing screening $30.83 V5010 Assessment for hearing $62.53

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

(b) Maximum Fees for Hearing Aids. The maximum fees are the adjusted acquisition cost (AAC) of the hearing aid, plus the appropriate dispensing fee.

1. Hearing Aid Dispensing Fees.

Code Description Rate V5090 Dispensing fee, unspecified hearing aid $331.26 V5110 Dispensing fee, bilateral $662.73 V5160 Dispensing fee, binaural $662.73 V5200 Dispensing fee, CROS contralateral, monaural $662.73 V5240 Dispensing fee, contralateral routing system, binaural $662.73 V5241 Dispensing fee, monaural hearing aid, any type $331.26

2. Hearing Aid Purchases.

Code Description Rate V5030 Hearing aid, monaural, body worn, air conduction AAC V5040 Hearing aid, monaural, body worn, bone conduction AAC V5050 Hearing aid, monaural, in the ear AAC V5060 Hearing aid, monaural, behind the ear AAC V5070 Glasses, air conduction AAC V5080 Glasses, bone conduction AAC V5095 Semi-implantable middle ear hearing prosthesis AAC V5100 Hearing aid, bilateral, body worn AAC V5120 Binaural, body AAC V5130 Binaural, in the ear AAC V5140 Binaural, behind the ear AAC V5150 Binaural, glasses AAC Hearing aid, contralateral routing device, monaural, in V5171 IC the ear (ITE) Hearing aid, contralateral routing device, monaural, in V5172 IC the canal (ITC) Hearing aid, contralateral routing device, monaural, V5181 IC behind the ear (BTE) V5190 Hearing aid, contralateral routing, monaural, glasses AAC Hearing aid, contralateral routing device, monaural, V5211 IC behind the ear (BTE) Hearing aid, contralateral routing system, binaural, V5212 IC ITE/ITC Hearing aid, contralateral routing system, binaural, V5213 IC ITE/BTE Hearing aid, contralateral routing system, binaural, V5214 IC ITC/ITC Hearing aid, contralateral routing system, binaural, V5215 IC ITC/BTE

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

Code Description Rate Hearing aid, contralateral routing system, binaural, V5221 IC BTE/BTE Hearing aid, contralateral routing system, binaural, V5230 AAC glasses Hearing aid, analog, monaural, CIC (completely in the V5242 AAC ear canal) V5243 Hearing aid, analog, monaural, ITC (in the canal) AAC Hearing aid, digitally programmable analog, monaural, V5244 AAC CIC Hearing aid, digitally programmable analog, monaural, V5245 AAC ITC Hearing aid, digitally programmable analog, monaural, V5246 AAC ITE (in the ear) Hearing aid, digitally programmable analog, monaural, V5247 AAC BTE (behind the ear) V5248 Hearing aid, analog, binaural, CIC AAC V5249 Hearing aid, analog, binaural, ITC AAC Hearing aid, digitally programmable analog, binaural, V5250 AAC CIC Hearing aid, digitally programmable analog, binaural, V5251 AAC ITC V5252 Hearing aid, digitally programmable, binaural, ITE AAC V5253 Hearing aid, digitally programmable, binaural, BTE AAC V5254 Hearing aid, digital, monaural, CIC AAC V5255 Hearing aid, digital, monaural, ITC AAC V5256 Hearing aid, digital, monaural, ITE AAC V5257 Hearing aid, digital, monaural, BTE AAC V5258 Hearing aid, digital, binaural, CIC AAC V5259 Hearing aid, digital, binaural, ITC AAC V5260 Hearing aid, digital, binaural, ITE AAC V5261 Hearing aid, digital, binaural, BTE AAC V5262 Hearing aid, disposable, any type, monaural AAC V5263 Hearing aid, disposable, any type, binaural AAC V5298 Hearing aid, not otherwise classified AAC

(c) Maximum Fees for Earmolds. Provider's adjusted acquisition cost (AAC), plus a dispensing fee as set forth in 130 CMR 323.03(5)(c).

Code Description Rate V5264 Ear mold/insert, not disposable, any type AAC+ $15.74 V5265 Ear mold/insert, disposable, any type AAC+ $15.74

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

(d) Maximum Fee for Ear Impressions.

Code Description Rate V5275 Ear impression, each $15.74

(e) Maximum Fees for Batteries.

Code Description Rate V5266 Battery for use in hearing device $1.67 Zinc air battery for use with cochlear implant device and L8621 auditory osseointegrated sound processors, replacement, AAC each Alkaline battery for use with cochlear implant device, L8622 AAC any size, replacement, each Lithium ion battery for use with cochlear implant device L8623 AAC speech processor, other than ear level, replacement, each Lithium ion battery for use with cochlear implant or L8624 auditory osseointegrated device speech processor, ear AAC level, replacement, each

(f) Maximum Fees for Bone-anchored Hearing Aids (BAHA).

Code Description Rate Auditory osseointegrated device, external sound L8691 processor, excludes transducer/actuator, replacement $1,931.37 only, each Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, L8692 IC includes headband or other means of external attachment Auditory osseointegrated device abutment, any length, L8693 $1,700.57 replacement only Auditory osseointegrated device, transducer/actuator, L8694 $1,059.11 replacement only, each

(g) Maximum Fees for Other Accessories. Provider's adjusted acquisition cost (AAC), plus a 45% markup.

Code Description Rate Hearing aid or assistive listening V5267 AAC+ 45% device/supplies/accessories, not otherwise specified V5274 Assistive listening device, not otherwise specified AAC+ 45%

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

(h) Maximum Fee for Refitting Services.

Code Description Rate V5011 Fitting/orientation/checking of hearing aid $37.35

(i) Maximum Fee for Minor Repairs.

Code Description Rate 99499 Unlisted evaluation and management service $5.38

(j) Maximum Fee for Major Repairs.

Code Description Rate V5014 Repair/modification of a hearing aid AAC+ 45%

(k) Maximum Fees for Cochlear Implant Services.

Code Description Rate Repair of prosthetic device, repair or replace minor parts (six-month maintenance and servicing fee for reasonable and necessary parts and labor that are not covered under L7510-MS any manufacturer or supplier warranty) (IC) (for use IC only for the purchase of a cochlear implant service contract in accordance with 130 CMR 426.416: Reimbursable Services.) Headset/headpiece for use with cochlear implant device, L8615 $337.44 replacement Microphone for use with cochlear implant device, L8616 $78.60 replacement Transmitting coil for use with cochlear implant device, L8617 $68.65 replacement Transmitter cable for use with cochlear implant device L8618 $19.62 or auditory osseointegrated device, replacement Cochlear implant, external speech processor and L8619 $7,259.54 controller, integrated system, replacement Cochlear implant, external speech processor, L8627 $6,518.03 component, replacement Cochlear implant, external controller component, L8628 $1,130.05 replacement Transmitting coil and cable, integrated, for use with L8629 $163.56 cochlear implant device, replacement Orthotic and prosthetic supply, accessory, and/or service L9900 IC component of another HCPCS L code

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Final Adoption Date Published in Mass. Register: November 21, 2025

101 CMR: EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES

.00: RATES FOR HEARING SERVICES

(l) Maximum Fee for Other Services.

Code Description Rate V5299 Hearing service, miscellaneous IC

(6) Medical Services. The payment rates for medical services are set forth in 101 CMR 317.00: Rates for Medicine Services.

(7) Therapeutic Services. The payment rates for therapeutic services are set forth in 101 CMR 339.00: Rates for Restorative Services.

323.04: Reporting Requirements

(1) Required Reports. Reporting requirements are governed by 957 CMR 6.00: Cost Reporting Requirements.

(2) Penalty for Noncompliance. The purchasing governmental unit may impose a penalty in the amount of up to 15% of its payments to any provider that fails to submit required information. The purchasing governmental unit will notify the provider in advance of its intention to impose a penalty under .04(2).

323.05: Severability

The provisions of .00 are severable. If any provision of .00 or application of any provision to an applicable individual, entity, or circumstance is held invalid or unconstitutional, that holding will not be construed to affect the validity or constitutionality of any remaining provisions of .00 or application of those provisions to applicable individuals, entities, or circumstances.

REGULATORY AUTHORITY

.00: M.G.L. c. 118E.

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