HEARING AID/AUDIOLOGY MAXIMUM ALLOWABLE FEE SCHEDULE THIS IS YOUR WISCONSIN MEDICAID MAXIMUM ALLOWABLE FEE SCHEDULE, WHICH IS IN EFFECT AS OF THE DATE OF THIS REPORT. WISCONSIN MEDICAID CERTIFIED PROVIDERS WILL BE REIMBURSED FOR SERVICES PROVIDED TO PROGRAM RECIPIENTS AT THE LOWER OF THEIR USUAL AND CUSTOMARY CHARGE, OR THE MAXIMUM ALLOWABLE FEE. SERVICES REIMBURSED BASED ON PROVIDER SPECIFIC (CONTRACTED RATES) AND REGIONAL OR SPECIALTY BASED RATES ARE NOT INCLUDED IN THIS FEE SCHEDULE. NOTE: BADGERCARE PLUS BENCHMARK PLAN MEMBERS WILL BE COVERED FOR HEARING AID/AUDIOLOGY SERVICES. THIS REPORT HAS BEEN MODIFIED TO INCLUDE A BENCHMARK COLUMN TO INDICATE WHICH SERVICES ARE COVERED BENFITS FOR BENCHMARK PLAN MEMBERS. ALTHOUGH THE FEE SCHEDULE DOES NOT ADDRESS THE VARIOUS COVERAGE LIMITATIONS ROUTINELY APPLIED BY WISCONSIN MEDICAID BEFORE FINAL PAYMENT IS DETERMINED (E.G., RECIPIENT AND PROVIDER ELIGIBILITY, BILLING INSTRUCTIONS, FREQUENCY OF SERVICES, THIRD PARTY LIABILITY, COPAYMENT, AGE RESTRICTIONS, PRIOR AUTHORIZATION, ETC.), IT DOES CONTAIN THE FOLLOWING INFORMATION: PROC/M1/M2/TM PROC - THE PROCEDURE CODE RECOGNIZED BY WISCONSIN MEDICAID TO IDENTIFY THE SERVICE PROVIDED. M1/M2 - ONE OR TWO APPLICABLE MODIFIER(S) AFFECTING REIMBURSEMENT AMOUNT. TM - DESCRIPTIVE MODIFIER USED TO CONVEY INFORMATION FORMERLY CONVEYED BY TOS. NOTE: IN CERTAIN INSTANCES THE MODIFIER LISTED IS BEING USED BOTH TO CONVEY INFORMATION FORMERLY CONVEYED BY TOS AND TO AFFECT THE REIMBURSEMENT AMOUNT. IN THESE INSTANCES THE MODIFIER WILL BE DISPLAYED TWICE, ONCE IN THE M1 OR M2 COLUMN AND ONCE IN THE TM COLUMN, EVEN THOUGH IT WILL ONLY BE BILLED ONCE ON THE CLAIM DETAIL. DESCRIPTION - AN ABBREVIATED DESCRIPTION OF THE PROCEDURE CODE PROVIDER TYPE - ALL APPLICABLE PERFORMING PROVIDER TYPES FOR THE PROCEDURE CODE. SEE TABLE I FOR A LISTING OF PROVIDER TYPES APPLICABLE TO THIS SCHEDULE. PAC - THE PRICING ACTION CODE IDENTIFIES NON-COVERED SERVICES OR THE SOURCE AND METHOD OF PRICING THE PROCEDURE (REFER TO TABLE II). EFFECT DATE - THE EFFECTIVE DATE OF SERVICE ON OR AFTER WHICH THE MAXIMUM ALLOWABLE FEE APPLIES. MAX FEE - MAXIMUM ALLOWABLE FEES FOR THE PROCEDURE CODES LISTED. IF A MAX FEE IS NOT INDICATED, USE THE PAC AND TABLE II TO DETERMINE THE REASON (E.G., PAC 21J INDICATES INDIVIDUAL CONSIDERATION, ETC.). BENCHMARK - INDICATES IF A PROCEDURE CODE IS A COVERED BENEFIT FOR BADGERCARE PLUS MEMBERS ENROLLED IN THE BENCHMARK PLAN. THIS INFORMATION IS INTENDED TO HELP YOU UNDERSTAND THE WISCONSIN MEDICAID MAXIMUM ALLOWABLE FEE SCHEDULE. IF YOU HAVE QUESTIONS,PLEASE CONTACT WISCONSIN MEDICAID PROVIDER SERVICES AT: (608) 221-9883 OR (800) 947-9627* *WHEN REQUESTING INFORMATION, PLEASE BE SPECIFIC AS TO WHICH PROVIDER TYPE YOU ARE REFERRING (I.E., SPEECH AND HEARING CLINIC,AUDIOLOGIST, HEARING INSTRUMENT SPECIALIST). TABLE I PROVIDER TYPES 36 - SPEECH AND HEARING CLINIC 37 - AUDIOLOGIST 84 - HEARING INSTRUMENT SPECIALIST TABLE II PRICING ACTION CODES (PAC) 11J, 21J - INDIVIDUAL CONSIDERATION, MEDICAL CONSULTANT 170, 270 - PAID AT THE LOWER OF THE BILLED AMOUNT OR MAXIMUM ALLOWABLE FEE ACCORDING TO PROVIDER TYPE TABLE III MODIFIERS MODIFIER DESCRIPTION -------------- ---------------------------------------------------------------------------------------------------------- RR RENTAL TC TECHNICAL COMPONENT 22 UNUSUAL PROCEDURAL SERVICES 26 PROFESSIONAL COMPONENT 52 REDUCED SERVICES PROC DESCRIPTION PROC M1 M2 TM PROVIDER TYPE PAC EFFECT MAX FEE BENCH DATE MARK 31575 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC 31575 36 270 10/01/02 70.96 Y 31579 LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY 31579 36 270 10/01/02 113.92 Y 69210 REMOVAL IMPACTED CERUMEN (SEPARATE PROCED URE), ONE OR BOTH EARS 69210 36 37 270 07/01/02 25.75 Y 92504 BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC PROCEDURE) 92504 36 37 270 07/01/02 23.86 Y 92506 EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING 92506 36 37 270 10/01/02 57.19 Y 92507 TREATMT OF SPEECH, LANGUAGE, VOICE, COMMUN, &/OR AUDITORY PROCSSING DISORDER; INDIVIDUAL 92507 36 37 270 10/01/03 45.18 Y 92508 TREAT OF SPEECH, LANG, VOICE, COMMUN, A/O AUDITORY PRCSSING DISORDER; 2 OR MORE INDIVIDU 92508 36 37 270 10/01/02 26.68 Y 92511 NASOPHARYNGOSCOPY WITH ENDOSCOPY (SEPARATE PROCEDURE) 92511 36 270 10/01/02 46.65 Y 92512 NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY) 92512 36 270 10/01/02 36.02 Y 92516 FACIAL NERVE FUNCTION STUDIES (EG ELECTRONEURONOGRAPHY) 92516 36 37 270 07/01/02 26.07 Y 92520 LARYNGEAL FUNCTION STUDIES (IE, AERODYNAMIC TESTING AND ACOUSTIC TESTING) 92520 36 270 10/01/02 29.29 Y 92526 TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING 92526 36 270 07/01/02 46.03 Y 92531 SPONTANEOUS NYSTAGMUS, INCLUDING GAZE 92531 36 37 270 07/01/02 57.53 Y 92532 POSITIONAL NYSTAGMUS TEST 92532 36 37 270 07/01/02 37.12 Y 92533 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION + 4 TESTS) 92533 36 37 270 07/01/02 24.22 Y 92534 OPTOKINETIC NYSTAGMUS TEST 92534 36 37 270 07/01/02 42.06 Y 92541 SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION 92541 TC 36 37 270 07/01/02 17.04 Y 92541 SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDING 92541 36 37 270 07/01/02 34.67 Y 92542 POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING 92542 36 37 270 07/01/02 30.70 Y 92542 POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING 92542 TC 36 37 270 07/01/02 17.94 Y 92543 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL = 4 TESTS), W RECORDING 92543 36 37 270 07/01/02 39.29 Y 92543 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL), WITH RECORDING 92543 TC 36 37 270 07/01/02 18.61 Y 92544 OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, W RECORDING 92544 36 37 270 07/01/02 23.77 Y 92544 OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, W RECORDING 92544 TC 36 37 270 07/01/02 14.36 Y 92545 OSCILLATING TRACKING TEST, WITH RECORDING 92545 36 37 270 07/01/02 20.46 Y 92545 OSCILLATING TRACKING TEST, WITH RECORDING 92545 TC 36 37 270 07/01/02 12.06 Y 92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING 92546 36 37 270 07/01/02 26.42 Y 92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING 92546 TC 36 37 270 07/01/02 79.17 Y 92547 USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 92547 36 37 270 07/01/02 18.16 Y 92548 COMPUTERIZED DYNAMIC POSTUROGRAPHY 92548 36 37 270 07/01/02 77.91 Y 92548 COMPUTERIZED DYNAMIC POSTUROGRAPHY 92548 TC 36 37 270 07/01/02 46.75 Y 92551 SCREENING TEST, PURE TONE, AIR ONLY 92551 36 37 270 07/01/02 12.56 Y 92552 PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY 92552 36 37 270 07/01/02 16.41 Y 92553 PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE 92553 36 37 270 07/01/02 23.11 Y 92555 SPEECH AUDIOMETRY THRESHOLD; 92555 36 37 270 07/01/02 14.51 Y 92556 SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION 92556 36 37 270 07/01/02 21.34 Y 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION & SPEECH RECOGNITION (92553 & 92556 ONLY) 92557 36 37 270 07/01/02 38.18 Y 92559 AUDIOMETRIC TESTING OF GROUPS 92559 36 37 270 07/01/02 21.98 Y 92560 BEKESY AUDIOMETRY; SCREENING 92560 36 37 270 07/01/02 17.78 Y 92561 BEKESY AUDIOMETRY; DIAGNOSTIC 92561 36 37 270 07/01/02 7.18 Y 92562 LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL 92562 36 37 270 07/01/02 8.31 Y 92563 TONE DECAY TEST 92563 36 37 270 07/01/02 9.17 Y 92564 SHORT INCREMENT SENSITIVITY INDEX (SISI) 92564 36 37 270 07/01/02 8.33 Y 92565 STENGER TEST, PURE TONE 92565 36 37 270 07/01/02 9.00 Y 92567 TYMPANOMETRY (IMPEDANCE TESTING) 92567 36 37 270 07/01/02 17.03 Y 92568 ACOUSTIC REFLEX TESTING; THRESHOLD 92568 36 37 270 07/01/02 12.94 Y 92569 ACOUSTIC REFLEX TESTING; DECAY 92569 36 37 270 07/01/02 14.64 Y 92571 FILTERED SPEECH TEST 92571 36 37 270 07/01/02 28.94 Y 92572 STAGGERED SPONDAIC WORD TEST 92572 36 37 270 07/01/02 17.35 Y 92575 SENSORINEURAL ACUITY LEVEL TEST 92575 36 37 270 07/01/02 17.35 Y 92576 SYNTHETIC SENTENCE IDENTIFICATION TEST 92576 36 37 270 07/01/02 17.35 Y 92577 STENGER TEST, SPEECH 92577 36 37 270 07/01/02 14.48 Y 92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) 92579 36 37 270 07/01/02 25.29 Y 92582 CONDITIONING PLAY AUDIOMETRY 92582 36 37 270 07/01/02 15.07 Y 92583 SELECT PICTURE AUDIOMETRY 92583 36 37 270 07/01/02 15.29 Y 92584 ELECTROCOCHLEOGRAPHY 92584 36 37 270 07/01/02 49.56 Y 92585 AUDITORY EVOKED POTENTAIL FOR EVOKED RESPONSE AUDIOMETRY A/O TEST OF CENTRAL NERVOUS SYS 92585 26 36 37 270 07/01/02 62.22 Y 92585 AUDITORY EVOKED POTENTIAL FOR EVOKED RESPONSE AUDIOMETRY A/O TEST OF CENTRAL NERVOUS SYS 92585 36 37 270 07/01/02 151.03 Y 92585 AUDITORY EVOKED POTENTIAL FOR EVOKED RESPONSE AUDIOMETRY A/O TEST OF CENTRAL NERVOUS SYS 92585 TC 36 37 84 270 07/01/02 93.35 Y 92587 EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, TRANSIENT/DISTORTION PRODU 92587 36 37 270 07/01/02 49.53 Y 92587 EVOKED OTOACOUSTIC EMISSIONS; LIMTED (SNGL STIMULUS LEVEL, EITHER TRANSIENT/DISTORTION) 92587 TC 36 37 84 270 07/01/02 47.77 Y 92588 COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIENT&/OR DISTORTION PRODUCT O 92588 36 37 270 07/01/02 68.33 Y 92588 EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE/DIAGNOSTIC EVALUATION (MULTI LEVELS & FREQ) 92588 TC 36 37 84 270 07/01/02 54.24 Y 92590 HEARING AID EXAMINATION AND SELECTION; MONAURAL 92590 36 37 270 07/01/04 22.93 Y 92591 HEARING AID EXAMINIATION AND SELECTION; BINAURAL 92591 36 37 270 07/01/04 25.41 Y 92592 HEARING AID CHECK; MONAURAL 92592 36 37 270 07/01/04 15.38 Y 92593 HEARING AID CHECK; BINAURAL 92593 36 37 270 07/01/04 19.40 Y 92594 ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL 92594 36 37 270 07/01/02 11.39 Y 92595 ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL 92595 36 37 270 07/01/02 14.36 Y 92596 EAR PROTECTOR ATTENUATION MEASUREMENTS 92596 36 37 270 07/01/02 10.36 Y 92597 EVAL FOR USE &/OR FITTING OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE COMMUNICATION 92597 36 270 10/01/03 71.61 Y 92601 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 YEARS OF AGE; WITH PROGRAMMING 92601 36 37 270 07/01/04 112.20 Y 92602 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, PATIENT UNDER 7 UEARS OF AGE; SUBSEQUENT REPROG 92602 36 37 270 07/01/04 76.90 Y 92603 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING 92603 36 37 270 07/01/04 69.32 Y 92604 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; SUBSEQUENT REPROGRAMMING 92604 36 37 270 07/01/04 49.43 Y 92607 EVAL FOR PRESCRIP FOR SPEECH-GENERATING AUGMENTATVE & ALT COMMUN DEVICE,FACE TO FACE 92607 36 270 10/01/03 59.97 Y 92608 EVAL FOR PRESCRIP FOR SPEECH-GENERATG AUGMNTVE & ALT COMM DEVCE,FACE TO FACE 92608 36 270 10/01/03 29.99 Y 92609 THERAPEUTIC SVCS FOR THE USE OF SPEECH-GENERATING DEVICE,INCL PROGRAMMING & MODIFICATION 92609 36 270 10/01/03 44.92 Y 92610 EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION 92610 36 270 10/01/03 68.10 Y 92611 MOTION FLUOROSCOPIC EVALUATION OF SWALLOWING FUNCTION BY CINE OR VIDEO RECORDING 92611 36 270 10/01/05 110.25 Y 92612 ENDOSCOPIC STUDY OF SWALLOWING FUNCTION (ALSO FIBEROPTIC ENDOSCOPIC EVAL OF SWALLOW (FEE 92612 36 270 10/01/05 131.16 Y 92614 SENSORY TESTING DURING ENDOSCOPIC STUDY OF SWALLOWING (ADD ON CODE) REFERRED TO AS FEEST 92614 36 270 10/01/05 123.18 Y 92620 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; INITIAL 60 MINUTES 92620 36 37 270 01/01/05 37.55 Y 92621 EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES 92621 36 37 270 01/01/05 9.50 Y 92625 ASSESSMENT OF TINNITUS (INCLUDES PITCH, LOUDNESS MATCHING, AND MASKING) 92625 36 37 270 01/01/05 36.92 Y 92626 EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR 92626 36 37 270 01/01/06 65.40 Y 92627 EVALUATION OF AUDITORY REHABILITATION STATUS; EACH ADDITIONAL 15 MINUTES 92627 36 37 270 01/01/06 16.35 Y 92630 AUDITORY REHABILITATION; PRE-LINGUAL HEARING LOSS 92630 36 37 270 01/01/06 79.95 Y 92633 AUDITORY REHABILITATION; POST-LINGUAL HEARING LOSS 92633 36 37 270 01/01/06 79.95 Y 92700 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE 92700 36 21J 10/01/03 Y V5014 REPAIR/MODIFICATION OF A HEARING AID (TO BE USED FOR MAJOR REPAIR) V5014 36 37 84 170 10/01/04 129.50 N V5014 22 36 37 84 170 03/01/03 60.88 N V5014 52 36 37 84 170 03/01/03 26.52 N V5050 HEARING AID, MONAURAL; IN THE EAR V5050 36 37 84 170 01/01/05 347.75 N V5050 HEARING AID, MONAURAL; IN THE EAR V5050 RR 36 37 84 170 03/01/03 27.34 N V5070 HEARING AID, MONAURAL; GLASSES; AIR CONDUCTION V5070 36 37 84 170 03/01/03 331.60 N V5070 HEARING AID, MONAURAL; GLASSES; AIR CONDUCTION V5070 RR 36 37 84 170 03/01/03 27.34 N V5080 HEARING AID, MONAURAL; GLASSES; BONE CONDUCTION V5080 36 37 84 170 03/01/03 331.60 N V5080 HEARING AID, MONAURAL; GLASSES; BONE CONDUCTION V5080 RR 36 37 84 170 03/01/03 27.34 N V5100 HEARING AID, BILATERAL, BODY WORN V5100 36 37 84 170 03/01/03 374.18 N V5100 HEARING AID, BILATERAL, BODY WORN V5100 RR 36 37 84 170 03/01/03 27.34 N V5110 DISPENSING FEE, BILATERAL V5110 36 37 84 170 03/01/03 537.53 N V5120 BINAURAL; BODY V5120 36 37 84 170 03/01/03 642.27 N V5120 BINAURAL; BODY V5120 RR 36 37 84 170 03/01/03 27.34 N V5130 BINAURAL; IN THE EAR V5130 36 37 84 170 01/01/05 695.50 N V5130 BINAURAL; IN THE EAR V5130 RR 36 37 84 170 03/01/03 27.34 N V5150 BINAURAL, GLASSES V5150 36 37 84 170 03/01/03 642.27 N V5150 BINAURAL, GLASSES V5150 RR 36 37 84 170 03/01/03 27.34 N V5160 DISPENSING FEE# BINAURAL V5160 36 37 84 170 07/01/02 537.53 N V5170 HEARING AID, CROS; IN THE EAR V5170 36 37 84 170 03/01/03 451.54 N V5170 HEARING AID, CROS; IN THE EAR V5170 RR 36 37 84 170 03/01/03 27.34 N V5190 HEARING AID, CROS; GLASSES V5190 RR 36 37 84 170 03/01/03 27.34 N V5190 HEARING AIDS, CROS; GLASSES. V5190 36 37 84 170 03/01/03 451.54 N V5200 DISPENSING FEE, CROS V5200 36 37 84 170 03/01/03 298.63 N V5210 HEARING AID, BICROS; IN THE EAR V5210 36 37 84 170 03/01/03 571.48 N V5210 HEARING AID, BICROS; IN THE EAR V5210 RR 36 37 84 170 03/01/03 27.34 N V5230 HEARING AID, BICROS; GLASSES V5230 36 37 84 170 03/01/03 571.48 N V5230 HEARING AID, BICROS; GLASSES V5230 RR 36 37 84 170 03/01/03 27.34 N V5240 DISPENSING FEE, BICROS V5240 36 37 84 170 03/01/03 537.53 N V5241 DISPENSING FEE, MONAURAL HEARING AID, ANY TYPE V5241 36 37 84 170 03/01/03 298.63 N V5242 HEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL) V5242 36 37 84 170 03/01/03 331.60 N V5242 HEARING AID, ANALOG, MONAURAL, CIC (COMPLETELY IN THE EAR CANAL) V5242 RR 36 37 84 170 03/01/03 27.34 N V5243 HEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL) V5243 36 37 84 170 03/01/03 331.60 N V5243 HEARING AID, ANALOG, MONAURAL, ITC (IN THE CANAL) V5243 RR 36 37 84 170 03/01/03 27.34 N V5244 HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, CIC V5244 36 37 84 170 03/01/03 377.67 N V5244 HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG, MONAURAL, CIC V5244 RR 36 37 84 170 03/01/03 27.34 N V5245 HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG MONAURAL, ITC V5245 36 37 84 170 03/01/03 377.67 N V5245 HEARING AID, DIGITALLY PROGRAMMABLE, ANALOG MONAURAL, ITC V5245 RR 36 37 84 170 03/01/03 27.34 N V5248 HEARING AID, ANALOG, BINAURAL, CIC V5248 36 37 84 170 03/01/03 642.27 N V5248 HEARING AID, ANALOG, BINAURAL, CIC V5248 RR 36 37 84 170 03/01/03 27.34 N V5249 HEARING AID, ANALOG, BINAURAL, ITC V5249 36 37 84 170 03/01/03 642.27 N V5249 HEARING AID, ANALOG, BINAURAL, ITC V5249 RR 36 37 84 170 03/01/03 27.34 N V5250 HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC V5250 36 37 84 170 03/01/03 755.34 N V5250 HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, CIC V5250 RR 36 37 84 170 03/01/03 27.34 N V5251 HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC V5251 36 37 84 170 03/01/03 755.34 N V5251 HEARING AID, DIGITALLY PROGRAMMABLE ANALOG, BINAURAL, ITC V5251 RR 36 37 84 170 03/01/03 27.34 N V5254 HEARING AID, DIGITAL, MONAURAL, CIC V5254 36 37 84 170 07/01/07 312.00 N V5254 HEARING AID, DIGITAL, MONAURAL, CIC V5254 RR 36 37 84 170 03/01/03 27.34 N V5264 EAR MOLD/INSERT, NOT DISPOSABLE, ANY TYPE V5264 36 37 84 170 03/01/03 42.58 N V5267 HEARING AID SUPPLIES/ACCESSORIES V5267 36 37 84 170 03/01/03 27.20 N V5273 ASSISTIVE LISTENING DEVICE, FOR USE WITH COCHLEAR IMPLANT V5273 36 37 84 170 03/01/03 177.16 N V5274 ASSISTIVE LEARNING DEVICE, NOT OTHERWISE SPECIFIED V5274 36 37 84 170 03/01/03 177.16 N V5274 ASSISTIVE LEARNING DEVICE, NOT OTHERWISE SPECIFIED V5274 RR 36 37 84 170 03/01/03 27.34 N V5275 EAR IMPRESSION, EACH V5275 36 37 84 170 03/01/03 20.00 N V5298 HEARING AID, NOT OTHERWISE CLASSIFIED V5298 36 37 170 10/01/04 2590.00 N V5299 HEARING SERVICE, MISCELLANEOUS V5299 36 37 84 11J 03/01/99 N V5336 REPAIR/MODIFICATION OF AUGMENTATIVE COMMUNICATIVE SYSTEM OR DEVICE (EXCL ADAPTIVE HEARIN V5336 36 11J 02/23/98 Y END OF REPORT