Medical Supplies and Equipment Benefit Lists

2.0 Audiology benefits list

For information on policies regarding the provision of audiology equipment and supplies, please consult the Guide for Medical Supplies and Equipment.

Audiology benefits list

List terminology

Item description:
Items are listed within general and specific categories (for example: Audiology), in alphabetical order by category and item.
Item code:
The 8-digit code that must be submitted to ESI Canada for billing purposes.
Prior approval:
Identifies by general category, or by item within the category, whether prior approval must be obtained by the provider before dispensing the item.
Recommended replacement guidelines:
Maximum number of each item a client may receive over a given period of time (frequency). Coverage of additional items may be considered on a case by case basis. For requests exceeding the recommended replacement guidelines, a prior approval is required.
Prescriber type:
AUD – Audiologist
ENT - Otorhinolaryngologist / Otolaryngologist
HIP – Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid DispenserFootnote *
MD – Physician
NP – Nurse Practitioner
Provider type:
AUD – Audiologist
GEN – Enrolled general MS&E and Pharmacy Provider
HIP – Hearing Instrument Practitioner or Audio-prosthetist or Hearing Aid Dispenser
Maximum Price:
The NIHB Program has established a maximum price coverage for certain items. The maximum national prices are shown in the tables below (please note that in some cases a price grid has been established for the provinces and one for the territories). The maximum prices for each province and territory are listed on the Express Script Canada website and can be viewed by clicking on the appropriate link in the benefit listings.

When a maximum price is established by the Program, the provider cannot claim a markup on the reimbursement request since it is included in the price.

2.1 Hearing aid, bone conduction

Hearing aids, bone conduction
Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price PrescriberFootnote * Provider
Bone anchored hearing system processor, left 99401229 Yes 1 every 5 years   AUD, ENT AUD
Bone anchored hearing system processor, right 99401228 Yes 1 every 5 years   AUD, ENT AUD
Bone conduction hearing aid, left 99400257 Yes As necessary, minimum of 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Bone conduction hearing aid, right 99400258 Yes As necessary, minimum of 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Softband 99401230 Yes 1 per year   AUD, ENT AUD

2.2 Hearing aid, CROS/BICROS

Hearing aids, CROS/BICROS
Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price PrescriberFootnote * Provider
BICROS 99400256 Yes As necessary, minimum of 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
CROS 99400255 Yes As necessary, minimum of 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP

2.3 Hearing aid, digital processing

Hearing aid, digital processing
Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price PrescriberFootnote * Provider
Completely in Canal Aid, left 99400646 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Completely in Canal Aid, right 99400647 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Digital basic, left 99400522 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Digital basic, right 99400523 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Digital custom, left 99400524 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP
Digital custom, right 99400525 Yes Every 5 years $575.00 MD, NP, AUD, HIPFootnote * AUD, HIP

2.4 Hearing implant processor

Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price Prescriber Provider
Cochlear implant processor, left 99401227 Yes 1 every 5 years   AUD, ENT AUD
Cochlear implant processor, right 99401226 Yes 1 every 5 years   AUD, ENT AUD

2.5 Hearing aid services, fees, repairs, and supplies

Hearing aid services, fees, repairs, and supplies
Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price PrescriberFootnote * Provider
BTE ear mold (new aid), left 99400266 Yes Every 5 years $45.00 AUD, HIPFootnote * AUD, HIP
BTE ear mold (new aid), right 99400267 Yes Every 5 years $45.00 AUD, HIPFootnote * AUD, HIP
Complete Hearing Assessment (performed bilaterally) 99400639 No 5 years Price File MD, NP, AUD, HIPFootnote * AUD, HIP
Fitting/ Dispensing fee, left 99401225 Yes As necessary, minimum of 5 years Price File MD, NP, AUD, HIPFootnote * AUD, HIP
Fitting/ Dispensing fee, right 99401224 Yes As necessary, minimum of 5 years Price File MD, NP, AUD, HIPFootnote * AUD, HIP
Hearing Aid Performance Check/ Readjustment (must be client initiated), left 99400640 Yes 1 per year (once the hearing aid warranty has expired) Price File AUD, HIPFootnote * AUD, HIP
Hearing Aid Performance Check/Readjustment (must be client initiated), right 99400641 Yes 1 per year (once the hearing aid warranty has expired) Price File AUD, HIPFootnote * AUD, HIP
Hearing Re-assessment (partial) (performed bilaterally - physician or client initiated) 99400642 Yes Every 2 years Price File MD, NP, AUD, HIPFootnote * AUD, HIP
Hearing aid return fee, left 99400264 Yes   Price File   AUD, HIP
Hearing Aid Return fee, right 99400265 Yes   Price File   AUD, HIP
In office service fee (includes supplies if necessary), left 99400274 No   $20.00   AUD, HIP
In office service fee (includes supplies if necessary), right 99400275 No   $20.00   AUD, HIP
Repairs by manufacturer, left 99400270 Yes outside warranty period $125.00   AUD, HIP
Repairs by manufacturer, right 99400271 Yes outside warranty period $125.00   AUD, HIP
Remake by manufacturer, left 99401122 Yes outside warranty period $176.00   AUD, HIP
Remake by manufacturer, right 99401123 Yes outside warranty period $176.00   AUD, HIP
Repairs out of office, dispenser service fee, left 99400272 Yes   Price File   AUD, HIP
Repairs out of office dispenser service fee, right 99400273 Yes   Price File   AUD, HIP
Replacement ear mold & impression fee, adult left 99400245 No 1 every 2 years Price File   AUD, HIP
Replacement ear mold & impression fee, adult right 99400246 No 1 every 2 years Price File   AUD, HIP
Replacement ear mold & impression fee, child, left 99400268 No 4 per year Price File   AUD, HIP
Replacement ear mold & impression fee, child, right 99400269 No 4 per year Price File   AUD, HIP
Delivery, hearing aid, charge from manufacturer 99401096 No per client order $8.00   AUD, HIP

2.6 Supplies outside manufacturer price list

Hearing aid supplies outside manufacturer price list
Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price PrescriberFootnote * Provider
Accessories/supplies 99400276 No 1 per 2 years $50.00 AUD, HIPFootnote * AUD, HIP
Batteries, hearing aid left 99400259 No maximum 24 batteries every 144 days $1.25 Northern Region $1.50   AUD, HIP, GEN
Batteries, hearing aid right 99400643 No maximum 24 batteries every 144 days $1.25 Northern Region $1.50   AUD, HIP, GEN
Parts for bone anchored hearing system processor 99400947 Yes     AUD AUD
Parts for cochlear implant processor 99400948 Yes     AUD AUD
Tubes/Domes OTE left 99400866 No 1 per year - set of 4 $20.00 AUD, HIPFootnote * AUD, HIP
Tubes/Domes OTE right 99400900 No 1 per year - set of 4 $20.00 AUD, HIPFootnote * AUD, HIP
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