2.0 Audiology equipment and supplies benefits list

Effective date: December 15, 2022

Table of contents

2.1 General information

2.1.1 Benefit Policies

General information common to all medical supplies and equipment (MS&E) can be found in the general policies.

2.1.2 Prescriber and provider requirements

Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the specific item as listed in the tables. Items that are prescribed by prescribers/recommenders not recognized by NIHB for the specific item will lead to denials or reversal of claims.

The following is a list of NIHB recognized prescriber/recommender abbreviations found in this segment of the benefits list. Please refer to the prescriber section of the item tables below to identify the eligible prescriber/recommender of a specific item:

  • AUD — Audiologist
  • ENT — Otorhinolaryngologist/Otolaryngologist
  • HIP* — Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid Dispenser
  • MD — Physician
  • NP — Nurse Practitioner

The following is a list of NIHB recognized provider abbreviations found in this segment of the benefits list. Please refer to the provider section of the item tables below to identify the eligible provider of a specific item:

  • AUD — Audiologist
  • GEN — Enrolled general MS&E and Pharmacy Provider
  • HIP — Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid Dispenser

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.1.3 Prior Approval Requirements

General prior approval requirements can be found in the general policies

To initiate the prior approval process; complete the Audiology Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website, and submit to the NIHB regional office along with the following supporting documentation:

  • the prescription/recommendation or referral form signed by a NIHB recognized prescriber for the requested benefit
  • the most recent audiometric test or an audiology assessment report which must be less than 6 months old. An audiometric test is not required for the replacement of a cochlear implant (CI) processor.
  • additional relevant information the provider, physician, nurse practitioner, or audiologist may have to support the request
  • an explanation of benefits from any third-party coverage available to the client (for example: provincial plan, workers' compensation board, private insurance, education plans, etc.)

Audiometric tests must be performed by either:

  • an Audiologist
  • a Hearing Instrument Practitioner* or Audio-prosthetist

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

Repairs require the following information on the prior approval request:

  • manufacturer name
  • model number or name
  • date fitted
  • serial number
  • description of the problem requiring the repair service
  • expiration date of the hearing device warranty

2.1.4 Exclusions

In addition to the general exclusion policy listed in the general policies, the following items are excluded from the audiology benefit and are not considered for coverage or appeal under the NIHB program:

  • items used exclusively for education/school (for example: classroom audio distribution systems, also known as sound field systems)
  • surgical implants (internal device for CI and bone-anchored hearing system (BAHS))
  • hearing protectors used in work-related situations
  • therapy treatment (for example, speech therapy)

2.1.5 Warranties

All hearing instruments and/or devices covered under the Hearing Industry Association of Canada (HIAC) agreement must carry, at a minimum, a two-year warranty and one-year 'loss and damage replacement' coverage at one occurrence per aid. Children under 18 years old receive, at minimum, a two-year 'loss and damage replacement' coverage at one occurrence per aid. NIHB clients must be entitled to the same warranties and provisions as all other clients. All items must have a 90-day return privilege at no cost to the client.

For other hearing devices (BAHS processor, CI processor and RM complete systems) the manufacturer's warranty and loss and damage replacement policy apply.

Follow-up:

Aftercare services take place when the original fitting and dispensing fee no longer covers the service provided.

Aftercare services involve:

  • adjustment to the client's fitting, including ear mold repairs or replacements
  • advice to the client outside a formal appointment, regarding their fitting or their hearing loss which is accommodated by the clinic and/or service provider

2.1.6 Repairs

Repairs are made to restore the hearing device to its original level of performance. A prescription is not needed for repairs; however a prior approval is required for all billable repairs.

Hearing device repairs done under warranty are not subject to service fees.

Repairs that are not covered under the warranty are eligible for coverage when supported by proper documentation.

The following rules apply:

  • warranty is expired
  • except for hearing aids, a detailed description of all repairs performed with dates and costs must be kept on file for each client
  • in the case of hearing aids, repairs must be covered according to the established price

2.1.6.1 Warranty on repairs

All repairs for RM systems, BAHS and CI processors must come with a minimum six-month warranty.

Hearing aid repair warranty periods must be consistent with the HIAC agreement:

  • repairs carried out on a hearing aid during the product purchase warranty period are guaranteed for a maximum of 12 months after repair or until the original product warranty expires, whichever comes first
  • all repairs and remakes carried out on a hearing aid after the warranty period expires will be subject to a maximum cost outlined in the pricing grid and will carry a 12-month warranty if the hearing device is less than five (5) years old
  • charges for repairs and remakes can only be billed after the warranty period, at least 24 months for new aids and 12 months after the repair or remake of an aid
  • a remake includes the provision of a new shell for the aid and replacement of required existing electronic components to ensure that the aid has been returned to the equivalent operating standard of a new aid

2.1.6.2 Repair timeline

  • the provider should have at least one permanent business location with the capacity to repair hearing devices and to send devices to manufacturers for repair
  • batteries and repair services must be available at the point of service during regular business hours
  • a loaner hearing device should be provided free of charge if requested by the client when same-day repairs cannot be completed
    • a Behind The Ear (BTE)-type hearing aid is an acceptable loan for In The Ear (ITE) and In The Canal (ITC) hearing aids
  • the device should be returned to the client promptly

2.1.7 Replacement requirements

Recommended replacement guidelines indicate the quantity and frequency at which a benefit item will be eligible for coverage. Recommended replacement guidelines are based on a client's customary medical needs and the typical device's lifespan.

All requests for replacement require a new prescription.

For more general information please see section 1.12 Recommended replacement guidelines.

2.1.7.1 Early replacement requirements

Coverage requests for any early replacement require prior approval, a new prescription as well as documentation supporting the need for early replacement. The client must meet program and equipment specific eligibility criteria.

Early replacement of items may be considered when one of the following has occurred:

  • there is a substantial change in a client's medical condition (for example substantial change in hearing, etc.) and the item no longer meets the client's needs
  • the item is no longer functioning properly, has deteriorated during typical use and is no longer under warranty (where the cost of repair exceeds the cost of a new item (except for items covered under an existing repair agreement))

The program will not cover the replacement of lost items (items no longer under loss warranty), stolen items, or items that are damaged due to misuse or negligence.

For items eligible for a trade-in allowance such as a cochlear implant processor, the trade-in value must be submitted with the prior approval request.

2.1.8 Services included in the price

Following a maximum ninety (90) day trial, clients may request the following services to be provided at no additional charge:

  • appropriate reinforcement of information, instructions, and retraining on the device
  • any modifications to improve the comfort of the device
  • any modifications to the electroacoustic characteristics of the device based upon reactions and experiences of the client
  • any adjustments or changes to amplification levels due to client reactions to enhance client benefit from the device
  • other further adjustments

2.1.9 Terminology

Item code

The item code is an 8-digit code that identifies the benefit being requested and is submitted to Express Scripts Canada for billing purposes.

Prior approval

A program coverage confirmation is issued by a NIHB regional office to a provider to ensure that the client is eligible for specific medical supplies and equipment benefits. The approval is issued primarily for items identified as requiring prior approval before being billed to the program.

Recommended replacement guidelines

The recommended replacement guidelines set a maximum number of each item a client may receive over a given period of time (frequency). Coverage of additional items may be considered on a case-by-case basis. For requests exceeding the recommended replacement guidelines, a prior approval is required.

Unit price

Unit price information may be found on the price files, located on the Express Scripts Canada NIHB provider and client website.

2.2 Hearing assessments

Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400639 Complete hearing assessment MD, NP, AUD, HIP AUD, HIP No 1 every 5 years
99400642 Hearing reassessment MD, NP, AUD, HIP AUD, HIP Yes 1 every 2 years To be used for all clients 18 years and older or any client under 18 that does not have a hearing aid, CI, BAHS etc.
99401244 Hearing reassessment pediatric initial (first hearing aid, CI, etc.) MD, NP, AUD AUD Yes 6 in first 2 years ( 4 in year 1 and 2 in year 2)

Code to be used for hearing tests conducted for pediatric populations (under 18) who are fit with amplification such as hearing aids, CI, bone anchored hearing system, etc. in order to monitor audiologic status during the first 2 years after fitting.

There should typically be a minimum of 3 months between each reassessment.

After 2 years use code 99401245 as applicable
99401245 Hearing reassessment pediatric annual MD, NP, AUD AUD Yes 1 per year To be used after expiration of code 99401244 for clients under 18 years who have a hearing aid, CI, etc.

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.3 Hearing devices

2.3.1 Hearing aids

2.3.1.1 Hearing aids criteria for children (under 18)

  • Clients are eligible for coverage if there is a hearing loss of 25 dB or greater at any frequency from 500 to 4000 Hz

2.3.1.2 Hearing aids criteria for adults

  • Clients are eligible for coverage if there is a total hearing loss of 100 dB or more (total of the thresholds at 500 Hz, 1000 Hz, 2000 Hz and 3000 Hz) or high-frequency hearing loss of 40 dB or more at 2 frequencies from 3000 to 6000 Hz.
    • Providers should perform a needs assessment using a standardized tool which includes client motivation to use a hearing device (for example, total or screening versions of the Hearing Handicap Inventory, the Client Oriented Scale of Improvement (COSI), etc). The needs assessment must be kept in the client's file and must be provided upon request for verification purposes.
Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99401255 Completely in canal or invisible in canal, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99401256 Completely in canal or invisible in canal, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400256 Hearing aid BiCROS AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400257 Hearing aid bone conduction, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400258 Hearing aid bone conduction, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400255 Hearing aid CROS AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400522 Behind-the-Ear hearing aid, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400523 Behind-the-Ear hearing aid, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400524 Hearing aid digital custom, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years
99400525 Hearing aid digital custom, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.3.2 Bone Anchored Hearing System (BAHS) processor

Audiologists prescribing or providing BAHS must work in a facility with a dedicated BAHS program or have training with BAHS and experience with clients having BAHS.

2.3.2.1 Eligibility criteria (initial)

  • the client has conductive/mixed hearing loss that cannot be treated medically and for whom an air conduction hearing aid is contraindicated (decision should be made by an audiologist and ENT physician)
  • the prescriber has identified the client as one who would benefit from BAHS
  • the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program

2.3.2.2 Eligibility criteria (replacement)

  • the BAHS processor currently in use is either:
    • 5 years old or older (from the original fitting date)
    • not working (and is no longer under warranty) and the cost of repair exceeds the cost of a new processor

2.3.2.3 Softband

2.3.2.3.1 Eligibility criteria (initial and replacement)
  • the client is too young (generally under 5 years) for a BAHS implant
  • when recommended by an audiologist for clients that cannot have an implant
Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401229 Hearing aid processor bone anchored, left AUD, ENT AUD Yes 1 every 5 years
99401228 Hearing aid processor bone anchored, right AUD, ENT AUD Yes 1 every 5 years
99400947 Parts for bone anchored hearing system AUD AUD Yes
99401230 Softband AUD, ENT AUD Yes 1 per year Client cannot have an implant usually due to age (under 5)

2.3.3 Cochlear implant (CI) processor

Audiologists prescribing or providing CIs must work in a facility with a dedicated CI program or have training with CIs and experience with clients having CIs.

2.3.3.1 Eligibility criteria (initial), children (under 18)

  • severe-to-profound sensorineural hearing loss bilaterally
  • receive little or no benefit from hearing aids
  • the prescriber has identified the client as one who would benefit from CI
  • the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program

2.3.3.2 Eligibility criteria (initial), adults

  • moderate to severe/profound sensorineural hearing loss
  • limited benefit from optimally fitted amplification
  • the benefit is not an insured service covered by a private or provincial/territorial health insurance plan or social program

2.3.3.3 Eligibility criteria (replacement), all ages

  • the CI processor currently in use is either:
    • 5 years old or older (from the original fitting date)
    • not working (and is no longer under warranty) and the cost of repair exceeds the cost of a new processor
Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401227 Cochlear implant processor, left AUD, ENT AUD Yes 1 every 5 years
99401226 Cochlear implant processor, right AUD, ENT AUD Yes 1 every 5 years
99400948 Parts for cochlear implant processor AUD AUD Yes

2.3.4 Remote Microphone (RM) complete system

To be eligible for a RM-complete system, the client must have at least ONE of the following:

  • the client has a unilateral or bilateral permanent hearing loss and has a justified need for a RM-complete system
  • the client has a need to improve functional auditory capacity that cannot be met with standard amplification
  • the client has been diagnosed with auditory neuropathy
Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400955 RM–complete system MD, NP, AUD, HIP AUD, HIP Yes 1 every 5 years RM-complete system includes a receiver, transmitter and all other accessories required for proper use and functioning (for example, audio shoes, charger, lanyard etc.)
99400962 RM-complete system fitting fee MD, NP, AUD, HIP AUD, HIP Yes 1 every 5 years
99401360 RM-complete system fitting fee - tele-audiology MD, NP, AUD, HIP AUD, HIP Yes 1 every 5 years For clients living in remote areas; only 1 fee, either the in-person or by tele-audiology, can be claimed once every 5 years.
99400960 Accessories for RM-complete system MD, NP, AUD, HIP AUD, HIP Yes 1 every 5 years
99400956 Audio shoe RM-complete system, left MD, NP, AUD, HIP AUD, HIP Yes 1 every 5 years
99400957 Audio shoe RM-complete system, right MD, NP, AUD, HIP AUD HIP Yes 1 every 5 years

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.3.5 Non-implantable bone conduction hearing system

To be eligible for a non-implantable bone conduction hearing system, the client must have ONE of the following:

  • the client has a bilateral or unilateral conductive hearing loss that cannot be addressed by conventional hearing aids. The client must have excellent bone conduction thresholds (5 to -5 dB) in the aided ear(s)
    • Examples include atresia or recurrent otitis media with effusion

    OR

  • the client has a single-sided sensorineural hearing loss and a trial with a CROS hearing aid was attempted with no success

    OR

  • the client is a candidate for surgical implantation who has not met the age requirement, a candidate for whom surgery is contra-indicated, or a candidate who is unwilling to undergo surgery
Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99401273 Adhesive adapter, left AUD, MD, NP, HIP AUD, HIP Yes 5 packages per year The package contains 15 adhesive adapters
99401274 Adhesive adapter, right AUD, MD, NP, HIP AUD, HIP Yes 5 packages per year The package contains 15 adhesive adapters
99401242 Adhesive wipes AUD, HIP AUD, HIP No 3 boxes per year
99401276 Cable, bone conduction hearing system AUD, MD, NP, HIP AUD, HIP Yes 1 every 2 years
99401271 Non-implantable bone conduction hearing system, left AUD, MD, NP, HIP AUD, HIP Yes 1 every 5 years Each new processor unit comes with 5 packages of adhesive adapters and an accessory box that includes:
  • 1 positioning tool
  • 1 retention cup
  • 1 cleaning brush
  • 3 colour sleeves
  • 1 pack of batteries (6)
  • 1 daily storage case
  • 1 sheet design stickers
  • 1 headband
99401272 Non-implantable bone conduction hearing system, right AUD, MD, NP, HIP AUD, HIP Yes 1 every 5 years Each new processor unit comes with 5 packages of adhesive adapters and an accessory box that includes:
  • 1 positioning tool
  • 1 retention cup
  • 1 cleaning brush
  • 3 colour sleeves
  • 1 pack of batteries (6)
  • 1 daily storage case
  • 1 sheet design stickers
  • 1 headband
99401275 Sound check tool, bone conduction hearing system AUD, MD, NP, HIP AUD, HIP Yes 1 every 5 years

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.4 Batteries and parts

2.4.1 Batteries

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400259 Batteries hearing aid, left GEN, AUD, HIP No 24 every 144 days
99400643 Batteries hearing aid, right GEN, AUD, HIP No 24 every 144 days
99401316 Batteries, non-implantable bone conduction, left GEN, AUD, HIP Yes 32 every 90 days
99401317 Batteries, non-implantable bone conduction, right GEN, AUD, HIP Yes 32 every 90 days
99400970 Disposable battery BAHS processor, left GEN, AUD, HIP No 3 per week
99400971 Disposable battery BAHS processor, right GEN, AUD, HIP No 3 per week
99400968 Disposable battery cochlear implant, left GEN, AUD, HIP No 7 per week
99400969 Disposable battery cochlear implant, right GEN, AUD, HIP No 7 per week
99401252 Rechargeable battery charger CI processor GEN, AUD, HIP No 1 every 5 years
99401251 Rechargeable battery CI processor, left   GEN, AUD, HIP No 1 per year Providers are required to bill according to the manufacturer price indicated in the price files for each battery type which can be found on the Express Scripts Canada NIHB provider and client website.
99401250 Rechargeable battery CI processor, right   GEN, AUD, HIP No 1 per year Providers are required to bill according to the manufacturer price indicated in the price files for each battery type which can be found on the Express Scripts Canada NIHB provider and client website.
99401248 Rechargeable battery hearing aid, left   GEN, AUD, HIP No 1 every 3 years
99401247 Rechargeable battery hearing aid, right   GEN, AUD, HIP No 1 every 3 years

2.4.2 Parts (including accessories and supplies)

Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400276 Accessories for hearing aids AUD, HIP AUD, HIP No 1 every 5 years

This code can only be used once every 5 years and can include more than one accessory, up to the unit price listed in the price files on the Express Scripts Canada NIHB provider and client website. If more than one accessory, all must be included on one reimbursement form. Providers should retain product information for warranty purposes.

Accessories include items that work in conjunction with hearing aid(s) to increase functionality and/or help in maintenance and may include but are not limited to: remote controls, audio streamers, microphones, dry aid kits, etc.

Rechargeable hearing aids typically come with a charger at no cost therefore the accessories code must not be used for a hearing aid charger.
99400266 Ear mold new, left AUD, HIP AUD, HIP Yes 1 every 5 years
99400267 Ear mold new, right AUD, HIP AUD, HIP Yes 1 every 5 years
99400245 Replacement ear mold & impression fee, adult, left AUD, HIP No 1 every 2 years The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for new ear molds is included in the fitting and dispensing fee for hearing aids
99401326 Receiver tube, replacement, left AUD, HIP AUD, HIP No 3 every 5 years

Receiver tube replacement is covered under the hearing aid warranty in the first 2 years.

This code should only be used when the hearing aid is no longer under warranty.

Claims submitted that do not meet this criteria are subject to reversal.
99401327 Receiver tube, replacement, right AUD, HIP AUD, HIP No 3 every 5 years

Receiver tube replacement is covered under the hearing aid warranty in the first 2 years.

This code should only be used when the hearing aid is no longer under warranty.

Claims submitted that do not meet this criteria are subject to reversal.
99400246 Replacement ear mold & impression fee, adult, right AUD, HIP No 1 every 2 years The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for new ear molds is included in the fitting and dispensing fee for hearing aids
99400268 Replacement ear mold & impression fee, child, left AUD, HIP No 4 per year The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for new ear molds is included in the fitting and dispensing fee for hearing aids
99400269 Replacement ear mold & impression fee, child, right AUD, HIP No 4 per year The fee for a replacement ear mold & impression is higher than the fee for a new ear mold because the impression fee for new ear molds is included in the fitting and dispensing fee for hearing aids
99400866 Tubes/domes over the ear, left AUD, HIP AUD, HIP No 1 pack of 4 per year Outside warranty period
99400900 Tubes/domes over the ear, right AUD, HIP AUD, HIP No 1 pack of 4 per year Outside warranty period

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.5 Servicing

2.5.1 Fees

Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99401225 Fitting and dispensing fee, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years Code for fitting and dispensing hearing aid by the provider while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counseling the client)
99401224 Fitting and dispensing fee, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years Code for fitting and dispensing hearing aid by the provider while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counseling the client)
99401356 Fitting and dispensing fee - tele-audiology, left AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years

Code for fitting and dispensing hearing aid by tele-audiology while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counseling the client).

For clients living in remote areas; only 1 fee, either the in-person or by tele-audiology, can be claimed once every 5 years.
99401357 Fitting and dispensing fee - tele-audiology, right AUD, HIP, MD, NP AUD, HIP Yes 1 every 5 years

Code for fitting and dispensing hearing aid by tele-audiology while the hearing aid is still under the manufacturer's warranty (for example, adjusting the hearing aid and counseling the client).

For clients living in remote areas; only 1 fee, either the in-person or by tele-audiology, can be claimed once every 5 years.
99400640 Hearing aid performance check and readjustment fee, left AUD, HIP AUD, HIP Yes 1 per year Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device (for example, electroacoustic evaluation, Real Ear Measures (REM), listening check, client interview) and making necessary adjustments to the device through programming, ear mold modification, etc. Must be client initiated
99400641 Hearing aid performance check and readjustment fee, right AUD, HIP AUD, HIP Yes 1 per year Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device (for example, electroacoustic evaluation, Real Ear Measures (REM), listening check, client interview) and making necessary adjustments to the device through programming, ear mold modification, etc. Must be client initiated
99401358 Hearing aid performance check and readjustment fee, tele-audiology, left AUD, HIP AUD, HIP Yes 1 per year Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device by tele-audiology. Must be client-initiated
99401359 Hearing aid performance check and readjustment fee, tele-audiology, right AUD, HIP AUD, HIP Yes 1 per year Code for checking and adjusting the hearing device no longer under the original manufacturer's warranty. Includes evaluating the performance of the device by tele-audiology. Must be client-initiated
99400274 In office service fee, left AUD, HIP No Service code for minor repairs to hearing aids in the office (for example, replacing the tubing on Behind The Ear (BTE) ear molds, replacing worn or malfunctioning parts, etc.) Includes supply if necessary.
99400275 In office service fee, right AUD, HIP No Service code for minor repairs to hearing aids in the office (for example, replacing the tubing on Behind The Ear (BTE) ear molds, replacing worn or malfunctioning parts, etc.) Includes supply if necessary.
99400272 Repairs out of office dispenser service fee, left AUD, HIP Yes Service code for any work/service carried out by the provider when the hearing device is sent to the manufacturer for repair. This code should only be used when the hearing aid is no longer under warranty.
99400273 Repairs out of office dispenser service fee, right AUD, HIP Yes Service code for any work/service carried out by the provider when the hearing device is sent to the manufacturer for repair. This code should only be used when the hearing aid is no longer under warranty.
99400264 Return fee hearing aid, left AUD, HIP Yes
99400265 Return fee hearing aid, right AUD, HIP Yes

* NIHB recognizes Hearing Instrument Practitioners (HIP) as prescribers/recommenders for audiometric tests and hearing equipment and supplies for adults 18 years of age or older. This applies in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes: Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Newfoundland.

2.5.2 Repairs and remake

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401122 Remake with repair by manufacturer, left AUD, HIP Yes Outside warranty period
99401123 Remake with repair by manufacturer, right AUD, HIP Yes Outside warranty period
99400966 Repair, BAHS processor, left AUD Yes
99400967 Repair, BAHS processor, right AUD Yes
99400964 Repair, cochlear implant processor, left AUD Yes
99400965 Repair, cochlear implant processor, right AUD Yes
99400963 Repair, RM systems AUD Yes
99400270 Repair, hearing aid manufacturer, left AUD, HIP Yes Outside warranty period
99400271 Repair, hearing aid manufacturer, right AUD, HIP Yes Outside warranty period
99401277 Repair, non-implantable bone conduction hearing system, left Yes
99401278 Repair, non-implantable bone conduction hearing system, right Yes

2.5.3 Delivery, shipping and handling

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400961 Shipping and handling, RM-complete system AUD, HIP No 1 per client order Charge from the manufacturer to the provider for shipping and handling of the RM-complete system
99401260 Delivery, audiology AUD, HIP Yes Delivery of equipment to the client
99401096 Shipping and handling, hearing aids AUD, HIP No 1 per client order Charge from the manufacturer to the provider for shipping and handling of hearing aids
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