La. Admin. Code tit. 40 § I-3325

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-3325 - Covered Services

A. The carrier/self-insured employer will pay for a hearing aid to correct trauma-induced hearing loss. The purchase and use of the hearing aid must be shown to improve the claimant's hearing ability and must be prescribed by an ear, nose and throat specialist or by a physician possessing a certificate of clinical competence in audiology (CCCA).

B. Definitions

1.Covered Hearing Aid Expense. Covered Hearing Aid Expense includes charges incurred for audiometric examinations, hearing aid evaluation tests, and hearing aids to the extent that charges are reasonable and customary as set forth below:

a. audiometric examination performed by a physician or audiologist;

b. hearing aid evaluation test performed by a physician or audiologist, which may include the trial and testing of various makes and models of hearing aids to determine which make and model will best compensate for the loss of hearing acuity but only when indicated by the most recent audiometric examination;

c. hearing aids of the following functional design: in-the-ear, behind-the-ear and on-the-body, but only if:

i. the hearing aid is prescribed based upon the most recent audiometric examination and most recent hearing aid evaluation test; and

ii. the hearing aid provided by the dealer is the make and model prescribed by the physician or audiologist and is certified as such by the physician or audiologist.

In order for the charges for services and supplies described in §3325. B.1 .a and b above to be covered, the audiometric examination must result in a determination that a hearing aid would compensate for the loss of hearing acuity.

2.Provider- a physician, audiologist or dealer.

a.Physician- an otologist or otolaryngologist who is board certified or eligible for certification in his/her specialty in compliance with the standards established by his/her respective professional sanctioning body, who is a licensed doctor of medicine or osteopathy legally qualified to practice medicine and who, within the scope of his/her license, performs a medical examination of the ear and determines whether the patient has a loss of hearing acuity and whether the loss can be compensated for by a hearing aid.

b.Audiologist- any person who meets the following criteria:

i. possesses a master's degree or doctorate degree in audiology or speech pathology from an accredited university;

ii. possesses a Certificate of Clinical Competence in Audiology or an Equivalency Certificate from the American Speech and Hearing Association; and

iii. is qualified, in the state in which the service is provided, to conduct an audiometric examination and hearing aid evaluation test for the purpose of measuring hearing acuity and determining and prescribing the type of hearing aid that would best improve the claimant's loss of hearing acuity.

(a).Dealer- any person or organization that sells hearing aids prescribed by a physician or audiologist to improve hearing acuity in compliance with the laws or regulations governing such sales.

3.Hearing Aid-

a. an electronic device worn on the person for the purpose of amplifying sound and assisting the physiologic process of hearing and includes the following, if necessary:

i. the single hearing aid unit;

ii. ear mold, necessary cords, tubing and connectors;

iii. standard package of batteries;

iv. earphone (often referred to as a receiver) or oscillator; and

v. one year warranty.

vi. The above mentioned hearing aid is covered by the carrier/self-insured employer only if:

(a). the claimant first obtains a medical examination of the ear by a physician and such examination, in conjunction with the audiometric examination, results in the determination that the prescribed hearing aid would compensate for the loss of hearing acuity; and

(b). the hearing aid provided by the dealer is the make and model prescribed by the physician or audiologist, unless any changes in the prescription are agreed upon by the physician or audiologist prior to dispensing the hearing aid.

4.Ear Mold- a device of soft rubber, plastic or nonallergenic material which may be vented or nonvented that individually is fitted to the external auditory canal and pinna of the patient.

5.Dispensing Fee- a fee to be paid to a dealer for dispensing hearing aids. This dispensing fee includes history (e.g., general information on patient environmental circumstances), fabrication and fitting of the ear mold, fitting the ear mold to the prescribed hearing aid, instructions in the wearing of the hearing aid and follow-up visits within a six-month period immediately following the fitting of the hearing aid.

6.Audiometric Examination- a procedure for measuring hearing acuity that includes history, procedures for measuring hearing acuity including tests relating to air conduction, bone conduction, speech reception threshold and speech discrimination, and summary and findings.

7.Hearing Aid Evaluation Test. T he hearing aid evaluation test is defined in two components as follows.

a.Hearing Aid Evaluation Test- a series of subjective and objective tests by which a physician or audiologist determines which make and model of hearing aid will best compensate for the loss of hearing acuity and which make and model will therefore be prescribed.

b.Conformity Evaluation (if a hearing aid is prescribed and fitted)-one visit to the prescribing physician or audiologist by the claimant subsequent to obtaining the hearing aid for an evaluation of its performance and a determination of its conformity to the prescription.

8.Hearing Aids-

a.Monaural- the standard unit which provides amplified sound for one ear only.

b.Cros (Contralateral Routing Signal) or "Cross Over" System- places a microphone behind the poorer ear and feeds the amplified sound to the better ear.

c.Bicros- consists of two microphones which send signals to a single amplifier.

d.Bilateral- a body-worn aid which feeds the sound from a microphone and amplifier located on the body to both ears via a "Y" cord and two receivers.

e.Binaural- a hearing aid system consisting of two complete hearing aids, two microphones, two amplifiers and two receivers, one for each ear.

f. Eyeglass hearing aids which are mounted in the stem of a pair of eyeglasses also are payable but only up to the monaural payment level. Therefore, reimbursement for such aids may include payment for special eyeglass frame fronts and/or optics as needed to accommodate the eyeglass type aid, provided payment does not exceed the charge for the covered hearing aid expense for one basic behind-the-ear type aid.

La. Admin. Code tit. 40, § I-3325

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.