Alabama Medicaid Agency · October 15, 2026 · Primary source
Coverage Update, Hearing Evaluation
What the document says
The Alabama Medicaid Agency issued a coverage update, effective October 1, 2026, directed to audiology providers. The update establishes that a hearing evaluation performed by a licensed physician must occur within six months prior to a hearing aid fitting in order to satisfy Medicaid coverage requirements. The requirement is codified at Alabama Administrative Code, Chapter 19, Rule No. 560-X-19-.01, governing Hearing Services. Claims for hearing aid services must be submitted in accordance with this updated coverage guideline to qualify for Medicaid reimbursement. The alert does not alter the underlying CPT billing codes for hearing evaluations but requires that the timing of the physician evaluation relative to the fitting date be documented and within the six-month window at the time of claim submission.
What this may mean
Applies to audiology providers billing Alabama Medicaid for hearing aid services on or after October 1, 2026. Claims for hearing aid fittings without a qualifying physician hearing evaluation dated within six months prior to the fitting date are out of compliance with Alabama Administrative Code Rule 560-X-19-.01 and subject to denial. Puts timely documentation of physician evaluation orders directly at issue for every hearing aid claim submitted to the Alabama Medicaid program.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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