Attention Section 60 and Section 109 Hearing Aid Providers: Binaural Hearing Billing and Prior Authorization (PA) Guidance Update

Effective November 15, 2025, MaineCare implemented a temporary process to support member access to hearing aids when a provider determines a member is clinically eligible for a binaural hearing aid, but the member only meets MaineCare Benefits Manual (MBM), Chapter II, Section 60: Durable Medical Equipment and Section 109: Speech and Hearing Services coverage criteria for a monaural hearing aid. This process will be effective until June 30, 2026 when LD 167, An Act to Provide 2 Hearing Aids to MaineCare Members with Diagnosed Hearing Loss becomes effective and removes certain requirements for members to access binaural hearing aids under the MaineCare program.

This temporary process allows MaineCare to review PA requests for binaural hearing aids and to approve those requests at 50% of the binaural hearing aid rates of reimbursement found in the State of Maine Contracts for the Procurement of Hearing Aids. This MaineCare PA approval process is intended to indicate that MaineCare’s approval and reimbursement is only for the covered monaural hearing aid when a member is determined to meet MaineCare criteria. We ask that providers proactively notify members of the upcoming statutory change to MaineCare’s coverage of binaural hearing aids effective July 1, 2026. Providers should inform members about this statutory change in MaineCare coverage so members can make an informed decision to obtain a hearing aid prior to July 1, 2026 at a cost to them, or wait to obtain a hearing aid after July 1, 2026 when it could be covered by the MaineCare program.

Required Provider Action

For correct review and processing, providers must submit these binaural hearing aid claims and PA requests with all of the following:

  • Proper binaural hearing aid Healthcare Common Procedure Coding System (HCPCS) code
  • UA modifier
  • All required PA documentation

MaineCare PA approvals will indicate the PA approval is only for the covered hearing aid, and not the non-covered hearing aid.

REMINDER – Billing Members for Non-covered Services

Providers may bill members for the non-covered portion of the binaural hearing aid claim only when they follow MBM, Chapter I, Section 1.06-4(A) by:

  • Prior to the provision of the service, the provider has clearly explained to the member that MaineCare does not cover the service and that the member will be responsible for the payment
  • Documenting in the member’s record the provider told the member, prior to provision, that the service was not a MaineCare covered service and the member is responsible for the payment.

For questions, please contact Shannon Beggs, Provider Relations Specialist.