FEES - COMPLETE TINNITUS EVALUATION

GENERAL NOTES IF THE BENEFIT GRID SPECIFIES A SPECIALIST, ONLY THAT SPECIALIST IS ACCEPTED. SHOULD "MD" BE INDICATED, THE SERVICE MAY BE PRESCRIBED/RECOMMENDED BY A GENERAL PRACTITIONER OR ANY MEDICAL SPECIALIST. COMMAS APPEARING IN THE "PRESCRIBER REQUIRED" AND "RECOMMENDER REQUIRED" COLUMNS INDICATE OR, EG. "MD", "RN" MEANS "MD" OR "RN". PROVIDER MUST SUPPLY A COPY OF THE MANUFACTURER'S INVOICE. THE DOLLAR LIMIT AND/OR FEE ON THE BENEFIT GRID INCLUDES THE MARK-UP PRE-AUTHORIZATION NOT REQUIRED FOR REPLACEMENT ISSUE UNLESS OTHERWISE INDICATED. SPECIAL NOTES NOTE 23 - TINNITUS EVALUATION INCLUDES: COMPLETION OF TINNITUS QUESTIONNAIRE ON THE EFFECT TINNITUS HAS ON CLIENT'S DAILY ROUTINE, MEASUREMENT OF HOW LOUD THE TINNITUS IS, DISCUSSION OF MANAGEMENT OPTIONS AND PROVIDING CLIENT WITH INFORMATION PACKAGE ABOUT TINNITUS.