Binaural Hearing Aid Billing and Prior Authorization (PA) Guidance Update for Hearing Aid Providers
On December 23, 2025, the Department issued temporary billing guidance for binaural hearing aids for dates of service (DOS) November 15, 2025, through June 30, 2026. This message is to remind providers the temporary billing process will end for DOS on or after July 1, 2026.
Effective July 1, 2026, providers should follow routine claims and PA submission processes for coverage of binaural hearing aids in accordance with criteria found in Maine P.L. 2025, Chapter 446 (also known as LD 167) - Act to Provide 2 Hearing Aids to MaineCare Members with Diagnosed Hearing Loss.
Billing Members for Non-Covered Services Reminder
Providers may bill members for non-covered services only when they follow MaineCare Benefits Manual (MBM) Chapter I, Section 1.06-4(A). To bill a member for a non-MaineCare covered service, the providers must:
- Clearly explain to the member prior to the provision of the service, that MaineCare does not cover the service and that the member will be responsible for the payment.
- Document in the member’s record about telling the member prior to provision of the service, 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.