Page 28 - Medicare Benefit Policy Manual

42 CFR 411.15(d) which specifically states that “hearing aids or examination for the
purpose of prescribing, fitting, or changing hearing aids” are excluded from coverage.

Hearing aids are amplifying devices that compensate for impaired hearing. Hearing aids
include air conduction devices that provide acoustic energy to the cochlea via stimulation
of the tympanic membrane with amplified sound. They also include bone conduction
devices that provide mechanical energy to the cochlea via stimulation of the scalp with
amplified mechanical vibration or by direct contact with the tympanic membrane or
middle ear ossicles.

Certain devices that produce perception of sound by replacing the function of the middle
ear, cochlea or auditory nerve are payable by Medicare as prosthetic devices. These
devices are indicated only when hearing aids are medically inappropriate or cannot be
utilized due to congenital malformations, chronic disease, severe sensorineural hearing
loss or surgery.

The following are prosthetic devices:

• Cochlear implants and auditory brainstem implants, i.e., devices that replace the
function of cochlear structures or auditory nerve and provide electrical energy to
auditory nerve fibers and other neural tissue via implanted electrode arrays.

• Osseointegrated implants, i.e., devices implanted in the skull that replace the
function of the middle ear and provide mechanical energy to the cochlea via a
mechanical transducer.

Medicare contractors deny payment for an item or service that is associated with any
hearing aid as defined above. See §180 for policy for the medically necessary treatment
of complications of implantable hearing aids, such as medically necessary removals of
implantable hearing aids due to infection.

110 - Custodial Care
(Rev. 1, 10-01-03)
A3-3159, HO-260.10, HO-261, B3-2326

Custodial care is excluded from coverage. Custodial care serves to assist an individual in
the activities of daily living, such as assistance in walking, getting in and out of bed,
bathing, dressing, feeding, and using the toilet, preparation of special diets, and
supervision of medication that usually can be self-administered. Custodial care
essentially is personal care that does not require the continuing attention of trained
medical or paramedical personnel. In determining whether a person is receiving
custodial care, the A/B MAC (A) or (B) considers the level of care and medical
supervision required and furnished. It does not base the decision on diagnosis, type of
condition, degree of functional limitation, or rehabilitation potential.