Better health and ageing for all Australians

Eligibility criteria for refitting

Eligibility Criteria for Refitting

The current device/s is unsuitable because

Evidence required on file

    1. Hearing levels show a significant and permanent change and the electro- acoustic response cannot be optimised by adjustments or any other modifications.
Audiograms show a significant permanent change. A significant change in HTLs is a deterioration of > 10dB at two or more frequencies.

Medical investigation / intervention confirms a significant permanent change (where appropriate - for example, where not previously medically assessed)

AND

Following adjustment/modification best insertion gain an /or coupler gain results show a poor match to targets

OR

Aid specifications show current hearing levels outside the range of the device (attach device spec sheet to file)

OR

Following adjustment/modification aids are a good match to targets on maximum settings but has nil or inadequate reserve gain of ≤ 5dB.

    2. Client has had deterioration in health, dexterity or cognitive ability.
Description of the deterioration and how this impacts on the client’s ability to manage their aids OR a letter from the client’s doctor, carer, nurse supervisor etc supporting how the condition affects aid management.

AND

What has been tried with current aids

AND

How the proposed device will address these difficulties

*Consideration must be given as to whether this client now meets Complex Client criteria.

    3. Client requires a different style of hearing aid due to a change in physical condition of the ear or ear health.
Description of change in client circumstances

AND

How the proposed aid will address current difficulties

AND

Otoscopy results describe change in physical condition of ear or change in ear health

AND

If the change in ear health is related to a medical condition that has not previously been medically assessed, evidence of medical referral.

4. Client requires refitting of one ear because there are contraindications to wearing two different aid types.File notes detailing why two different aid styles/types cannot or will not be physically manageable for the client

OR

File notes detailing why two different aids of differing sound quality, each optimally fitted, cannot be tolerated by the client.

Where an aid is different to the previous aid that is being replaced, and the 2nd ear is being refitted for compatibility reasons, a binaural fitting item 830 should be claimed.

5. Aid has a history of malfunction/unreliability and client requires full rehabilitation program.Device must be out of warranty period

AND

Documented history of an aid routinely malfunctioning or becoming unreliable, that is

  • ≥ 3 major mechanical failures within 12mths or
  • ≥ 4 significant wax issues within 12mths (include what has been tried with wax management to solve issues)

OR

A letter from the manufacturer to indicate that the device is in poor condition

Devices that have more recently been approved on the Schedule of devices should be fitted.

6. Client has a clinical need for telecoil and current aid(s) do not have telecoil and cannot be retrofitted with one. Where device was fitted prior to 1/7/12. #Stated specific goal which can only be met with the inclusion of a Telecoil

AND

Statement from manufacturer that Telecoil cannot be retrofitted without reshelling and/or faceplate modification

AND

Documentation on file indicates a change in client needs relating to Telecoil since the last fitting.

# From 1/7/12, client must opt-out of having a telecoil.

7. Client has occlusion that cannot be resolved by vent modification or reshelling.Documentation of previous attempts to resolve occlusion through vent enlargement or reshelling
8. Client originally fitted with an ALD and now has communication goals indicating hearing aid fitting.Current communication goals show clinical need for hearing aid(s).
9. Client’s current device(s) was fitted more than 6 years ago and there are identified needs for new hearing devices and a full rehabilitation program.Documented rehabilitation program including review of client communication needs, motivation and expectations and negotiated goals.
10. Client’s current device(s) cannot be adjusted or modified to adapt to a significant change in living or social environment.Documentation that client has had a significant change in living or social circumstances, e.g. has moved from living alone to a residential aged care facility environment or in with a family member.

AND

clinical notes document what has been tried with the current aids to address client’s communication difficulties

AND

the client’s file documents change of address to an aged care facility, or other evidence of change to living environment.

Inappropriate fitting by another provider Top of Page
The practitioner may proceed with a rehabilitation plan that may include refitting (if clinically required) after obtaining and reviewing the client’s file from the previous provider. Practitioners do not need to contact the Office. Once the client rehabilitation plan is concluded, the practitioner may make a complaint to the Office if they believe the fitting by the previous provider was inappropriate. The complaint should be made in writing by email to Office of Hearing Services. The clinical and other reasons for refitting a hearing device should be fully documented on the client’s file.






Remote control approvals
A remote control can be provided and claimed where required due to clinical need. A completed Remote Control Requirement Form, a copy of the manufacturer’s invoice, and a manual claim form is to be submitted to OHS Claims in Central Office, Canberra email: OHS Claims.

Spare aids
Most spare aids can be fitted and claimed using the Spare Aid Guidelines.
Where a spare aid is lost/DBR or no longer suitable they are most likely to be replacement aids.
Contact OHS claims for advice if unsure.

A PDF Version of the Eligibility Criteria for Refitting is available via the link below:

The PDF Version of Eligibility Criteria for Refitting (PDF 92 KB is available.

If you are having any problems downloading attached content or viewing links on this page please email:Office of Hearing Services.
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