3/11/2011
Printable Version (PDF)
AUDIOLOGY INFORMATIONAL NOTICE
TO: Audiologists, CFC Program Managers, Service Coordinators
FROM: Janet D. Gully, Chief Bureau of Early Intervention
DATE: March 10, 2011
SUBJECT: AUDIOLOGY EVALUATIONS AND EARLY INTERVENTION: CLARIFICATION OF
BILLABLE SERVICES
This notice is to clarify early intervention (EI) evaluation and assessment services performed by audiologists that are billable to the Early Intervention Services System. When reading this notice, please keep in mind that EI is Part C of the Individuals with Disabilities Education Act (IDEA) and is a developmental program governed by the United States Department of Education, Office of Special Education Programs (OSEP). EI does not pay for therapeutic services required due to or as part of, a medical procedure, a medical intervention or an injury. Acute rehabilitative therapy and therapy required as part of a medical procedure, medical intervention or injury is not developmentally based but is medically based. Services that are medically based must be billed to resources other than EI.
All EI services are pre-authorized by a child's service coordinator. Audiologists should never complete audiological evaluations or hearing aid assessments without having an authorization in hand. Evaluations/assessments completed without an authorization in hand are not guaranteed for payment. Service coordinators have been advised to never backdate an authorization for payment for audiological evaluations or assessments that they had no previous knowledge of.
EI Referrals for Audiological Evaluation
EI service coordinators will generate authorizations to an EI enrolled audiologist for an audiological evaluation if any of the following situations apply:
- child presents a possible hearing loss at referral
- a possible hearing loss was identified via parent report during intake or at any other time during the Individualized Family Service Plan (IFSP) process
- a child fails a functional hearing screening completed during evaluations to determine eligibility for EI
- a member of the EI service team identifies a possible hearing loss after the IFSP was initially developed and direct services have begun
- child has failed the initial newborn hearing/screening test and there has been no follow up to that failed test
- prior to the annual IFSP meeting, if needed
Once a hearing loss has been established, EI pays for developmental services via authorizations for aural rehabilitation services as described in the most current provider handbook entitled Early Intervention Service Descriptions, Billing Codes and Rates.
EI service coordinators will not generate authorizations and EI will not pay for the following types of evaluations and services:
- evaluations completed without a referral from the service coordinator
- evaluations completed prior to the receipt of an EI authorization
- ongoing evaluations to monitor a diagnosed hearing loss. This is a medical service that must be billed to and paid by resources other than EI
- ongoing evaluation to monitor a fluctuating hearing loss. This is a medical service that must be billed to and paid by resources other than EI
- evaluations to determine if a child is a candidate for a cochlear implant. A cochlear implant is a medical intervention
- follow up visits to monitor cochlear implants. Follow up visits to monitor cochlear implants are medical services to monitor a medical intervention
EI Referrals for Hearing Aid Assessments
EI service coordinators will generate authorizations for hearing aid assessments if the following situations apply.
- Child presents with an established hearing loss and may need hearing aids
- An audiological evaluation completed via an EI authorization has established a hearing loss and the child may need hearing aids
New Information: Effective immediately EI service coordinators will not generate authorizations and EI will not pay for additional hearing aid assessments once the need for hearing aids has been determined and prior approval obtained from the appropriate payee (EI or Division of Specialized Care for Children). If it is determined that a child requires hearing aids and the appropriate payee is EI, EI service coordinators will generate authorizations for the hearing aid(s) and the dispensing fee. EI will not pay additional charges for freight, postage, delivery, instruction, fitting, adjustments, or measurement, as these services are considered to be "all-inclusive" in a payee's charge for the
item or service requested. Additional charges cannot be billed to the family. Please refer to your "Illinois Department of Human Services, Payee Agreement for Authorization to Provide Early Intervention Services", numbers 1, 6 & 7 for information on billing families for EI services.
If you have questions about this Informational Notice please contact the Child & Family Connections (CFC) office(s) that you currently accept referrals from or you may contact Colleen Cunningham at colleen.cunningham@illinois.gov or Jennifer Kepner at jennifer.kepner@illinois.gov. Thank you for your continued participation as a provider of services for the Early Intervention Services System.
