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Code · California · Welfare and Institutions Code

§ 14105.49

297 words·~1 min read·/ca/welfare-and-institutions-code/14105-49

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(1)The department shall establish a list of Healthcare Common Procedure Coding System (HCPCS) codes billable to the Medi-Cal program and reimbursement rates, subject to Section 51319 of Title 22 of the California Code of Regulations, hearing aids, and the list shall be published in the Medi-Cal Provider Manual.
(2)The department may implement this section by provider manual or bulletin. Notwithstanding the provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of the Government Code), actions of the department under this section shall not be subject to the rulemaking provisions of the Administrative Procedure Act or to the review and approval of the Office of Administrative Law.
(b)The maximum reimbursement rate for hearing aids shall not exceed the lesser of the following:
(1)The maximum allowable amount established by the department.
(2)The one-unit wholesale cost, plus a markup determined by the department.
(3)The billed amount.
(4)The rate established by the department’s contracting program.
(c)The maximum reimbursement rate for hearing aid supplies and accessories shall not exceed the lesser of the following:
(1)The retail price.
(2)The wholesale cost, plus a markup determined by the department.
(3)The billed amount.
(4)The rate established by the department’s contracting program.
(d)The maximum reimbursement rate for molds or inserts shall not exceed the lesser of the following:
(1)The maximum amount allowable established by the department.
(2)The billed amount.
(3)The rate established by the department’s contracting program.
(e)The maximum reimbursement for repairs, subsequent to the guarantee period, shall not exceed the lesser of the following:
(1)The invoice cost plus a markup determined by the department.
(2)The billed amount.
(3)The rate established by the department’s contracting program.
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