ACCESSORIES (INCLUDING WIRELESS) ENTRY LEVEL HEARING AIDS

GENERAL NOTES IF THE BENEFIT GRID SPECIFIES A SPECIALIST, ONLY THAT SPECIALIST IS ACCEPTED. SHOULD "MD" BE INDICATED, THE SERVICE MAY BE PRESCRIBED/RECOMMENDED BY A GENERAL PRACTITIONER OR ANY MEDICAL SPECIALIST. COMMAS APPEARING IN THE "PRESCRIBER REQUIRED" AND "RECOMMENDER REQUIRED" COLUMNS INDICATE OR, EG. "MD", "RN" MEANS "MD" OR "RN". PROVIDER MUST SUPPLY A COPY OF THE MANUFACTURER'S INVOICE. THE DOLLAR LIMIT AND/OR FEE ON THE BENEFIT GRID INCLUDES THE MARK-UP PRE-AUTHORIZATION NOT REQUIRED FOR REPLACEMENT ISSUE UNLESS OTHERWISE INDICATED. SPECIAL NOTES NOTE 33: PROVIDERS MAY BILL THE MANUFACTURER'S INVOICE PRICE PLUS UP TO A 25% MARK-UP. IF THERE IS A DOLLAR LIMIT AND/OR FEE ON THE BENEFIT GRID THIS INCLUDES THE MARK-UP. NOTE 35: THIS CODE IS ONLY TO BE USED FOR ACCESSORIES WHICH ARE BILLED BY THE MANUFACTURER AS THEY ARE NOT PART OF THE OPTIONAL COMPLIMENTARY ACCESSORIES OFFERED AT TIME OF MONAURAL OR BINAURAL HEARING AID ORDERS; OR FOR ACCESSORIES BILLED BY THE MANUFACTURER AS THEY WERE NOT ORDERED IN CONJUNCTION WITH THE HEARING AID(S) (E.G. THEY WERE ORDERED OVER 6 MONTHS AFTER THE DATE OF SERVICE (PER THE MOU AGREEMENT, EFFECTIVE NOVEMBER 15, 2022).