The following modifiers are allowable for contracted hearing aid models.
| Modifier | Description |
|---|---|
| LT | Left side |
| RR* | Rental |
| RT | Right side |
| *The maximum allowable fee for all rentals is $27.34 per 30-day period. All rented hearing instruments require PA. Wisconsin Medicaid and BadgerCare Plus do not reimburse providers for dispensing fees for rental hearing instruments. | |
Wisconsin Medicaid and BadgerCare Plus will approve only medically necessary hearing aid models available through a volume purchase contract. These procedure codes are allowable for the corresponding hearing aid models. Many of the manufacturers and models listed in this table are registered or trademarked by the manufacturer. All new hearing aid orders have a two-year manufacturer warranty.
| V5030 — Hearing aid, monaural, body worn, air-conduction hearing aid (Applicable modifiers: LT, RR, RT) | ||||
| Manufacturer and Style | Model | Purchase Rate | Repair Rate Per Unit | Repair Warranty |
| Rexton | Fusion PP+ (1 receiver) | $175.00 | $89.00 | 12 months |
| V5040 — Hearing aid, monaural, body worn, bone-conduction hearing aid (Applicable modifiers: LT, RR, RT) | ||||
| Manufacturer and Style | Model | Purchase Rate | Repair Rate Per Unit | Repair Warranty |
| Rexton | Fusion PP+ (1 receiver/headband) | $255.95 | $89.00 | 12 months |
| V5100 — Hearing aid, bilateral, body worn, air-conduction hearing aid (Applicable modifiers: LT, RR, RT) | ||||
| Manufacturer and Style | Model | Purchase Rate | Repair Rate Per Unit | Repair Warranty |
| Rexton | Fusion PP+ (2 receivers with Y-cord) | $267.40 | $89.00 | 12 months |
| V5180 — Hearing aid, CROS; behind the ear (Applicable modifiers: LT, RR, RT) (For BICROS, use V5220 [Applicable modifier: LT, RR, RT]) | ||||
| Manufacturer and Style | Model | Purchase Rate for CROS/BICROS | Repair Rate Per Unit | Repair Warranty |
| Oticon, Inc. | Acto CROS or BICROS | $425.00 | $80.00 $100.00 | 6 months 12 months |
| Acto Power CROS or BICROS | $425.00 | |||
| Chili SP5 CROS or BICROS | $425.00 | |||
| Get CROS or BICROS | $274.00 | |||
| Get Power CROS or BICROS | $274.00 | |||
| GoPro CROS or BICROS | $274.00 | |||
| GoPro VC CROS or BICROS | $274.00 | |||
| GoPro Power CROS or BICROS | $274.00 | |||
| GoPro Power Direct CROS or BICROS | $274.00 | |||
| Ino CROS or BICROS | $350.00 | |||
| Ino Power CROS or BICROS | $350.00 | |||
| Ino Pro CROS or BICROS | $400.00 | |||
| Ino Pro Power CROS or BICROS | $400.00 | |||
| Safari 300 CROS or BICROS | $350.00 | |||
| Safari 300 Power CROS or BICROS | $350.00 | |||
| Safari 300 Super Power CROS or BICROS | $374.00 | |||
| Safari 600 Power CROS or BICROS | $474.00 | |||
| Sumo E CROS or BICROS | $374.00 | |||
| Sumo XP CROS or BICROS | $474.00 | |||
| Unitron Hearing, Inc. | Tandem 4 CROS or BICROS | $870.86 | $150.00 | 12 months |
| V5220 — Refer to V5180. |
| V5256 — Hearing aid, digital, monaural, ITE (Applicable modifiers: LT, RR, RT) (For binaural, use V5260 [Applicable modifier: RR]) | |||||
| Manufacturer and Style | Model | Purchase Rate for Monaural | Purchase Rate for Binaural | Repair Rate Per Unit | Repair Warranty |
| Audina Hearing Instruments, Inc. | Intuition 2+ | $199.00 | $398.00 | $85.00 $100.00 | 6 months 12 months |
| Intuition 2FC+ | $225.00 | $450.00 | |||
| Intuition 4+ | $325.00 | $650.00 | |||
| Intuition 4AD | $350.00 | $700.00 | |||
| Intuition 12 | $400.00 | $800.00 | |||
| Intuition 12AD | $425.00 | $850.00 | |||
| Simplex | $160.00 | $320.00 | |||
| Simplex FC | $175.00 | $350.00 | |||
| Beltone Electronics — Full Shell | Origin 2-Optima | $201.00 | $402.00 | $97.30 | 12 months |
| Origin 3-Optima | $317.25 | $634.50 | |||
| True 3-Optima | $349.80 | $699.60 | |||
| True 6-Optima | $366.50 | $733.00 | |||
| Beltone Electronics — Half Shell | Origin 2-Optima | $238.50 | $477.00 | ||
| Origin 3-Optima | $354.75 | $709.50 | |||
| True 3-Optima | $379.80 | $759.60 | |||
| True 6-Optima | $391.50 | $783.00 | |||
| Beltone Electronics — Low Profile | Origin 2-Optima | $216.00 | $432.00 | ||
| Origin 3-Optima | $332.25 | $664.50 | |||
| True 3-Optima | $361.80 | $633.60 | |||
| True 6-Optima | $376.50 | $753.00 | |||
| Hansaton Acoustics, Inc. | Cemia | $285.00 | $570.00 | $100.00 | 12 months |
| Lumeo | $360.00 | $720.00 | |||
| Veneto | $410.00 | $820.00 | |||
| Magnatone Hearing Aid Corp. (dba Persona Medical) | Claret 300 | $162.25 | $324.50 | $100.00 | 6 months |
| Monet 300 | $192.25 | $384.50 | |||
| Oticon, Inc. — Full Shell | GO Pro | $199.00 | $398.00 | $80.00 $100.00 | 6 months 12 months |
| Oticon, Inc. — Half Shell | Acto HS | $350.00 | $700.00 | ||
| Acto HS Power | $350.00 | $700.00 | |||
| Get HS | $199.00 | $398.00 | |||
| Get HS Power | $199.00 | $398.00 | |||
| GO Pro HS | $199.00 | $398.00 | |||
| GO Pro HS Power | $199.00 | $398.00 | |||
| Ino HS | $275.00 | $550.00 | |||
| Ino HS Power | $275.00 | $550.00 | |||
| Ino Pro HS | $325.00 | $650.00 | |||
| Ino Pro HS Power | $325.00 | $650.00 | |||
| Oticon, Inc. — Low Profile | Acto LP | $350.00 | $700.00 | ||
| GO Pro LP | $199.00 | $398.00 | |||
| GO Pro LP Power | $199.00 | $398.00 | |||
| Ino Pro LP | $325.00 | $650.00 | |||
| Phonak Hearing Systems, LLC — Full Shell | Cassia 13 UZ | $385.00 | $770.00 | $110.00 | 12 months |
| Dalia 13 UZ | $299.00 | $598.00 | |||
| Milo Plus FS DAZ | $225.00 | $450.00 | |||
| Milo Plus FS Power DAZ | $225.00 | $450.00 | |||
| Phonak Hearing Systems, LLC — Half Shell | Cassia 312 | $385.00 | $770.00 | ||
| Cassia 312 Petite | $385.00 | $770.00 | |||
| Cassia 312 UZ | $385.00 | $770.00 | |||
| Cassia 312 UZ Petite | $385.00 | $770.00 | |||
| Dalia 312 | $299.00 | $598.00 | |||
| Dalia 312 Petite | $299.00 | $598.00 | |||
| Dalia 312 UZ | $299.00 | $598.00 | |||
| Dalia 312 UZ Petite | $299.00 | $598.00 | |||
| Milo Plus HS dAZ | $225.00 | $450.00 | |||
| Resound — Full Shell | Alera 5 | $397.50 | $795.00 | $95.00 Monaural $190.00 Binaural |
12 months |
| Alera 5 Directional | $397.50 | $795.00 | |||
| Alera 5 Power | $397.50 | $795.00 | |||
| Alera 5 Directional Power | $397.50 | $795.00 | |||
| Alera 5 Remote Mic | $397.50 | $795.00 | |||
| Alera 5 Remote Mic Power | $397.50 | $795.00 | |||
| Alera 5 Remote Mic Ultra Power | $397.50 | $795.00 | |||
| Live 5 | $312.75 | $625.50 | |||
| Live 5 Directional | $312.75 | $625.50 | |||
| Live 5 Power | $312.75 | $625.50 | |||
| Live 5 Directional Power | $312.75 | $625.50 | |||
| VEA 2 | $247.50 | $495.00 | |||
| VEA 2 Directional | $247.50 | $495.00 | |||
| VEA 2 Power | $247.50 | $495.00 | |||
| VEA 2 Directional Power | $247.50 | $495.00 | |||
| VEA 3 | $277.50 | $555.00 | |||
| VEA 3 Directional | $277.50 | $555.00 | |||
| VEA 3 Power | $277.50 | $555.00 | |||
| VEA 3 Directional Power | $277.50 | $555.00 | |||
| Resound — Half Shell | Alera 5 | $397.50 | $795.00 | ||
| Alera 5 Directional | $397.50 | $795.00 | |||
| Alera 5 Power | $397.50 | $795.00 | |||
| Alera 5 Directional Power | $397.50 | $795.00 | |||
| Live 5 | $312.75 | $625.50 | |||
| Live 5 Directional | $312.75 | $625.50 | |||
| Live 5 Power | $312.75 | $625.50 | |||
| Live 5 Directional Power | $312.75 | $625.50 | |||
| VEA 2 | $247.50 | $495.00 | |||
| VEA 2 Directional | $247.50 | $495.00 | |||
| VEA 2 Power | $247.50 | $495.00 | |||
| VEA 2 Directional Power | $247.50 | $495.00 | |||
| VEA 3 | $299.70 | $599.40 | |||
| VEA 3 Directional | $299.70 | $599.40 | |||
| VEA 3 Power | $299.70 | $599.40 | |||
| VEA 3 Directional Power | $299.70 | $599.40 | |||
| Rexton — Full Shell and Half Shell Note: There is no charge for optional D-mic, telecoil, or switchless telecoil. | Arena 1S | $191.75 | $383.50 | $89.00 | 12 months |
| Bridge 8+ | $408.85 | $817.70 | $165.00 | ||
| Day 4+ | $243.75 | $487.50 | |||
| Day 6+ | $302.25 | $604.50 | |||
| Day 6+ Energy | $302.25 | $604.50 | |||
| Siemens Hearing Instruments, Inc. — Full Shell and Half Shell | Intuis | $259.48 | $518.96 | $95.00 | 12 months |
| Phoenix G3 | $249.08 | $498.16 | |||
| Sonic Innovations — Full Shell | Velocity 4 ITED | $209.00 | $418.00 | $145.00 Monaural $290.00 Binaural | 12 months |
| Velocity 4 ITEPD | $209.00 | $418.00 | |||
| Velocity 6 ITED | $259.00 | $518.00 | |||
| Velocity 6 ITEPD | $259.00 | $518.00 | |||
| Sonic Innovations — Half Shell | Velocity 4 HSD | $209.00 | $418.00 | ||
| Velocity 6 HSD | $259.00 | $518.00 | |||
| Starkey Laboratories, Inc. — Full Shell and Half Shell | Ignite 20 | $289.00 | $578.00 | $84.99 | 24 months |
| Ignite i20 | $339.00 | $678.00 | |||
| Ignite 30 | $319.00 | $638.00 | |||
| Ignite i30 | $359.00 | $718.00 | |||
| Wi Series i70 | $389.00 | $778.00 | |||
| Wi Series i90 | $409.00 | $818.00 | |||
| Wi Series i110 | $429.00 | $858.00 | $84.99 | 36 months | |
| X Series 70 | $379.00 | $758.00 | $84.99 | 24 months | |
| X Series 90 | $399.00 | $798.00 | |||
| X Series 110 | $419.00 | $838.00 | |||
| Unitron Hearing, Inc. — Full Shell and Half Shell | Latitude 8 | $374.00 | $748.00 | $75.00 | 12 months |
| Latitude 16 | $435.00 | $870.00 | |||
| Quantum 6 | $395.00 | $790.00 | |||
| Quantum 12 | $448.00 | $896.00 | |||
| Shine+ | $229.49 | $458.98 | |||
| Shine+ Power | $229.49 | $458.98 | |||
| Widex Hearing — Full Shell and Half Shell | Clear 220 C2 | $425.00 | $850.00 | $100.00 | 12 months |
| Mind 220 M2 | $350.00 | $700.00 | |||
| Mesa 3 ME3 | $199.00 | $398.00 | |||
| V5257 — Hearing aid, digital, monaural, BTE (Applicable modifiers: LT, RR, RT) (For binaural, use V5261 [Applicable modifier: RR]) | |||||
| Manufacturer and Style | Model | Purchase Rate for Monaural | Purchase Rate for Binaural | Repair Rate Per Unit | Repair Warranty |
| Audina Hearing Instruments, Inc. | 478 | $245.00 | $490.00 | $150.00 | 12 months |
| 478P+ | $245.00 | $490.00 | |||
| Intuition 2 | $200.00 | $400.00 | |||
| Intuition 2FC | $225.00 | $450.00 | |||
| Intuition 4+ | $300.00 | $600.00 | |||
| Intuition 4AD | $325.00 | $650.00 | |||
| Opti-Trim | $175.00 | $350.00 | |||
| Simplex | $200.00 | $400.00 | |||
| Simplex 2P+ | $175.00 | $350.00 | |||
| Sparo | $325.00 | $650.00 | $200.00 | 12 months | |
| Sparo 2+ | $250.00 | $500.00 | |||
| Sparo AD | $350.00 | $700.00 | |||
| Beltone Electronics | Change 62D | $341.25 | $682.50 | $97.30 | 12 months |
| Origin 2-75D | $337.35 | $674.70 | |||
| Origin 2-85D | $395.85 | $791.70 | |||
| Origin 3-65D | $369.85 | $739.70 | |||
| Origin 3-75D | $369.85 | $739.70 | |||
| Origin 3-85D | $367.95 | $735.90 | |||
| True 3-66DW | $391.28 | $782.56 | |||
| Turn TN1T75 | $160.30 | $320.60 | |||
| Turn TN3T85 | $226.85 | $453.70 | |||
| Turn TN3T95 | $317.85 | $635.70 | |||
| Hansaton Acoustics, Inc. | Base HP | $200.00 | $400.00 | $100.00 | 12 months |
| Base MP | $200.00 | $400.00 | |||
| Cemia Mini | $250.00 | $500.00 | |||
| Cemia Power | $250.00 | $500.00 | |||
| Cemia Slim | $250.00 | $500.00 | |||
| Cemia X Mini RIC | $250.00 | $500.00 | |||
| Lumeo Mini | $325.00 | $650.00 | |||
| Lumeo Power | $325.00 | $650.00 | |||
| Lumeo Slim | $325.00 | $650.00 | |||
| Lumeo X Mini RIC | $325.00 | $650.00 | |||
| Magnatone Hearing Aid Corp. (dba Persona Medical) | Claret 310 | $175.23 | $350.46 | $100.00 | 6 months |
| Claret 315 | $175.23 | $350.46 | |||
| Claret 320 | $175.23 | $350.46 | |||
| Claret 325 | $175.23 | $350.46 | |||
| Claret 330 | $175.23 | $350.46 | |||
| Claret 335 | $175.23 | $350.46 | |||
| Monet 320 | $207.63 | $415.26 | |||
| Monet 325 | $207.63 | $415.26 | |||
| Monet 330 | $207.63 | $415.26 | |||
| Oticon, Inc. | Acto | $350.00 | $700.00 | $80.00 $100.00 | 6 months 12 months |
| Acto Mini | $350.00 | $700.00 | |||
| Acto RITE | $350.00 | $700.00 | |||
| Acto Mini RITE | $350.00 | $700.00 | |||
| Acto Power | $350.00 | $700.00 | |||
| Chili SP5 | $350.00 | $700.00 | |||
| Get | $199.00 | $398.00 | |||
| Get Power | $199.00 | $398.00 | |||
| GoPro | $199.00 | $398.00 | |||
| GoPro VC | $199.00 | $398.00 | |||
| GoPro Power | $199.00 | $398.00 | |||
| GoPro Power Direct | $199.00 | $398.00 | |||
| Ino | $275.00 | $550.00 | |||
| Ino Mini | $275.00 | $550.00 | |||
| Ino RITE | $275.00 | $550.00 | |||
| Ino Mini RITE | $275.00 | $550.00 | |||
| Ino Power | $275.00 | $550.00 | |||
| Ino Pro | $325.00 | $650.00 | |||
| Ino Pro Mini | $325.00 | $650.00 | |||
| Ino Pro Mini RITE | $325.00 | $650.00 | |||
| Ino Pro Power | $325.00 | $650.00 | |||
| Ino Pro RITE | $325.00 | $650.00 | |||
| Safari 300 | $275.00 | $550.00 | |||
| Safari 300 Power | $275.00 | $550.00 | |||
| Safari 300 Super Power | $299.00 | $598.00 | |||
| Safari 600 | $399.00 | $798.00 | |||
| Safari 600 Power | $399.00 | $798.00 | |||
| Phonak Hearing Systems, LLC | Audeo S Mini III | $385.00 | $770.00 | $110.00 | 12 months |
| Audeo S Smart I | $299.00 | $598.00 | |||
| Audeo S Smart III | $385.00 | $770.00 | |||
| Audeo S Yes III | $385.00 | $770.00 | |||
| Cassia M H2O | $385.00 | $770.00 | |||
| Cassia Micro M | $385.00 | $770.00 | |||
| Cassia Micro P | $385.00 | $770.00 | |||
| Cassia SP | $385.00 | $770.00 | |||
| Cassia Petite | $385.00 | $770.00 | |||
| Dalia M H2O | $299.00 | $598.00 | |||
| Dalia Micro M | $299.00 | $598.00 | |||
| Dalia Micro P | $299.00 | $598.00 | |||
| Dalia SP | $299.00 | $598.00 | |||
| Milo Plus Micro | $225.00 | $450.00 | |||
| Milo Plus SP | $225.00 | $450.00 | |||
| Milo Plus UP | $225.00 | $450.00 | |||
| Nadia S CRT III | $385.00 | $770.00 | |||
| Nadia S I SP | $299.00 | $598.00 | |||
| Nadia S III SP | $385.00 | $770.00 | |||
| Nadia S I UP | $299.00 | $598.00 | |||
| Nadia S III UP | $385.00 | $770.00 | |||
| NIOS H20 III | $385.00 | $770.00 | |||
| Resound | Alera 5 RIE | $397.50 | $795.00 | $95.00 Monaural $190.00 Binaural | 12 months |
| Dot 10 | $312.75 | $625.50 | |||
| Live 5 RIE | $312.90 | $625.80 | |||
| Live 5 Silhouette DVI | $338.23 | $676.46 | |||
| Live 5 Silhouette Mini DI | $338.23 | $676.46 | |||
| Live 5 Silhouette Power | $372.80 | $745.60 | |||
| Sparx Super Power | $312.75 | $625.50 | |||
| VEA 2 Power | $277.50 | $555.00 | |||
| VEA 2 Standard | $277.50 | $555.00 | |||
| VEA 3 Mini | $277.50 | $555.00 | |||
| VEA 3 Power | $277.50 | $555.00 | |||
| VEA 3 Standard | $277.50 | $555.00 | |||
| Rexton | Arena 1S | $191.75 | $383.50 | $89.00 | 12 months |
| Cobalt ECO+ RIC | $302.25 | $604.50 | $165.00 | ||
| Day 4+ Free | $243.75 | $487.50 | $135.00 | ||
| Day 4+ HP | $243.75 | $487.50 | |||
| Day 4+ Open | $243.75 | $487.50 | |||
| Day 4+ P | $243.75 | $487.50 | |||
| Day 6+ Free | $302.25 | $604.50 | |||
| Day 6+ HP | $302.25 | $604.50 | |||
| Day 6+ Open | $302.25 | $604.50 | |||
| Day 6+ P | $302.25 | $604.50 | |||
| Onyx EOC+RIC | $315.25 | $630.50 | |||
| Siemens Hearing Instruments, Inc. | Life 101 | $316.68 | $633.36 | $95.00 | 12 months |
| Sonic Innovations | Endura 6 | $285.00 | $570.00 | $145.00 Monaural $290.00 Binaural | 12 months |
| Flip 60 Mini RIC | $285.00 | $570.00 | |||
| Ion | $169.00 | $338.00 | |||
| Velocity 4 | $209.00 | $418.00 | |||
| Velocity 6 | $259.00 | $518.00 | |||
| Velocity 6 Mini | $259.00 | $518.00 | |||
| Starkey Laboratories, Inc. | 3 Series 70 m | $389.00 | $798.00 | $84.99 | 27 months |
| 3 Series i70 m | $399.00 | $798.00 | |||
| 3 Series 70 RIC | $389.00 | $798.00 | |||
| 3 Series i70 RIC | $399.00 | $798.00 | $84.99 | 39 months | |
| Ignite 20 mini | $289.00 | $578.00 | $84.99 | 27 months | |
| Ignite 20 RIC 13 | $289.00 | $578.00 | |||
| Ignite i20 RIC 13 | $339.00 | $678.00 | |||
| Ignite 20 RIC 312 | $289.00 | $578.00 | |||
| Ignite i20 RIC 312 | $339.00 | $678.00 | |||
| Ignite 30 mini | $319.00 | $638.00 | |||
| Ignite 30 RIC 13 | $319.00 | $638.00 | |||
| Ignite i30 RIC 13 | $359.00 | $718.00 | |||
| Ignite 30 RIC 312 | $319.00 | $638.00 | |||
| Ignite i30 RIC 312 | $359.00 | $718.00 | |||
| Tour 20 mini | $299.00 | $598.00 | |||
| Tour i20 mini | $349.00 | $698.00 | |||
| Tour 20 RIC | $299.00 | $598.00 | |||
| Tour i20 RIC | $349.00 | $698.00 | |||
| Tour 30 mini | $329.00 | $658.00 | |||
| Tour i30 mini | $369.00 | $738.00 | |||
| Tour 30 RIC | $329.00 | $658.00 | |||
| Tour i30 RIC | $369.00 | $738.00 | |||
| Wi Series i70 RIC 13 | $389.00 | $778.00 | |||
| Wi Series i70 RIC 312 | $389.00 | $778.00 | |||
| X Series 70 m | $379.00 | $758.00 | |||
| X Series 70 RIC 13 | $379.00 | $758.00 | |||
| X Series 70 RIC 312 | $379.00 | $758.00 | |||
| X Series 90 m | $399.00 | $798.00 | |||
| X Series 90 RIC 13 | $399.00 | $798.00 | |||
| X Series 90 RIC 312 | $399.00 | $798.00 | |||
| Unitron Hearing, Inc. | 360e Super Power | $322.00 | $644.00 | $75.00 | 12 months |
| Latitude 8 | $374.80 | $749.60 | |||
| Latitude 8 HP | $374.80 | $749.60 | |||
| Latitude 8 Moda | $374.80 | $749.60 | |||
| Latitude 8 Moxi 3G | $374.80 | $749.60 | |||
| Moxi 3 CRT | $320.67 | $641.34 | |||
| Moxi E CRT P | $320.67 | $641.34 | |||
| Moxi 6 CRT HP | $395.00 | $790.00 | |||
| Moxi 6 CRT P | $395.00 | $790.00 | |||
| Moxi 6 CRT S | $395.00 | $790.00 | |||
| Moxi 6 CRT SP | $320.67 | $641.34 | |||
| Quantum 6 | $395.00 | $790.00 | |||
| Quantum 6 HP | $395.00 | $790.00 | |||
| Quantum 6 Micro | $395.00 | $790.00 | |||
| Quantum E HP | $320.67 | $641.34 | |||
| Quantum E S | $320.67 | $641.34 | |||
| Quantum E M | $320.67 | $641.34 | |||
| Shine+ | $229.49 | $458.98 | |||
| Shine+ HP | $229.49 | $458.98 | |||
| Shine+ Moda II | $229.49 | $458.98 | |||
| Widex Hearing | Menu ME3-M | $199.00 | $398.00 | $100.00 | 12 months |
| Menu ME3-9 | $199.00 | $398.00 | |||
| Menu ME3-19 | $199.00 | $398.00 | |||
| Mind 220 m2-9 | $350.00 | $700.00 | |||
| Mind 220 m2-9VC | $350.00 | $700.00 | |||
| Mind 220 m2-19 | $350.00 | $700.00 | |||
| Mind 220 m2-19VC | $350.00 | $700.00 | |||
| Mind 220 m2-m | $350.00 | $700.00 | |||
| V5260 — Refer to V5256. |
| V5261 — Refer to V5257. |