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    v1.0.28
    OpenPayerPolicy UpdatesOtorhinolaryngology (ENT)Ambetter Nevada BAHA Coverage Update | OpenPayer
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    CurrentAmbetter NevadaPolicy CP.MP.93

    Bone-Anchored Hearing Aid

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    This policy governs medical necessity for initial bone-anchored hearing aids, implantable or head-band devices, and replacement of BAHA devices or external sound processors for members with conductive, mixed, or unilateral sensorineural hearing loss that cannot be adequately restored with conventional air-conduction hearing aids.

    Policy Summary
    PayerAmbetter Nevada
    PolicyBone-Anchored Hearing Aid
    Policy CodePolicy CP.MP.93
    Change TypeAnnual reviewno material clinical or coverage changes
    Effective DateSep 1, 2026
    Last ReviewMay 1, 2026
    Next Review DateNot specified
    Key ActionFor Medicare members, review all applicable Medicare National and Local Coverage Determinations and Medicare Coverage Articles before applying this policy’s criteria.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    ≥60%Unaided speech discrimination
    <10 dB

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    Bilateral threshold difference
    <20 dBHearing-ear threshold
    5 yearsProcessor age for replacement
    6Qualifying initial indications

    Medical Necessity Requirements

    Initial BAHA

    Covered as medically necessary when all of the following are met; the qualifying clinical indication criterion requires at least one listed indication.

    Initial BAHA medical necessity

    • Device type and age: Use an implantable device for members age ≥5 years, or a head-band device for members age <5 years or who are medically unable to have an implant.Implantable: ≥5 years; head band: <5 years or medically unable to have an implant
    • Hearing loss and conventional-aid limitation: The member has unilateral or bilateral conductive and/or mixed hearing loss, or unilateral sensorineural hearing loss, and the condition prevents restoration of hearing using a conventional air-conduction hearing aid.
    • Audiometric requirements: The pure tone average bone-conduction threshold, measured at 0.5, 1, 2, and 3 kHz, is consistent with the FDA indications for the requested device, and the unaided speech discrimination score is at least 60%.Unaided speech discrimination ≥60%
    • Bilateral BAHA symmetry: For bilateral BAHA, the mean maximum difference between the right and left bone-conduction thresholds is less than 10 dB.<10 dB

      Applies only to bilateral BAHA requests.

    • Unilateral deafness hearing-ear threshold: For unilateral deafness, the hearing ear has a bone-conduction threshold of less than 20 dB.<20 dB

      Applies only to unilateral deafness requests.

    • Qualifying clinical indication

      • Ear-canal malformation: Congenital or surgically induced malformation of the ear canal such that it does not exist or cannot accommodate a standard air-conduction hearing aid, provided that the nerve is functional.
      • Chronic infection or dermatitis of the middle or outer ear is exacerbated by a standard air-conduction hearing aid.
      • Allergic reaction: The member has an allergic reaction to standard air-conduction hearing aids.
      • Acquired unilateral deafness: Unilateral deafness occurred after removal of an acoustic neuroma, trauma, a viral or vascular insult, or from idiopathic causes.
      • Tumor: The member has a tumor of the external canal and/or tympanic cavity.

    Replacement device or external sound processor

    Replacement of a BAHA and/or external sound processor is medically necessary when any one of the following is met.

    Replacement medical necessity

    • Device no longer functional: The existing device or devices are no longer functional and cannot be repaired.
    • Change in condition: A change in condition makes the existing unit or units inadequate for hearing-related activities of daily living, and improvement is expected with the replacement unit or units.
    • Processor age: The current sound processor is at least five years old.At least five years

    Replacement or upgrade of an existing properly functioning BAHA or external sound processor is excluded when requested only for convenience or simply to obtain newer technology before the applicable replacement timeframe.

    Replacement or upgrade is not medically necessary when the existing BAHA or external component is functioning properly and the request is based only on convenience or an early technology upgrade. In particular, replacement requested before the current sound processor is at least five years old does not meet this policy criterion.

    Codes and Key Coding Thresholds

    CPT CodesCPT
    69710Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone.
    69711Removal or repair of electromagnetic bone conduction hearing device in temporal bone.
    69714Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor.
    69716Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex.
    69717Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor.
    69719Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone.
    69726Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor.
    69727Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex.
    69728Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex.
    69729Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex.
    1–10 of 11
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    HCPCS CodesHCPCS
    L8690Auditory osseointegrated device, includes all internal and external components.
    L8691Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each.
    L8692Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.
    L8693Auditory osseointegrated device abutment, any length, replacement only.
    L8694Auditory osseointegrated device, transducer/actuator, replacement only, each.
    Coverage Threshold
    Implantable device ageAt least 5 years for an implantable device
    Coverage Threshold
    Unaided speech discriminationAt least 60%
    Coverage Threshold
    Bilateral bone-conduction threshold differenceMean maximum difference of less than 10 dB between the right and left bone-conduction thresholds
    Coverage Threshold

    Review and Denial Risks

    Documentation Required

    Review Medicare coverage authorities

    For Medicare members, review all applicable Medicare National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Medicare Coverage Articles before applying this policy’s criteria.

    Denial Risk

    Meet all initial device criteria

    Initial BAHA requests may be denied unless all eligibility, hearing-loss, audiometric, and clinical-indication criteria are met. Confirm that conventional air-conduction hearing aids cannot restore hearing and document the applicable audiometric thresholds and at least one qualifying clinical indication.

    • Implantable device: age ≥5 years; head-band device: age <5 years or medically unable to have an implant.
    • Unaided speech discrimination score: ≥60%.
    • For bilateral BAHA: mean maximum right-to-left bone-conduction difference <10 dB.

    Clinical Background

    BAHA devices transmit sound through bone directly to the inner ear. Implantable devices use a skull implant with an external processor, while head-band devices may be used when implantation is not feasible, including in younger children or members who are medically unable to undergo implantation.

    Policy Definitions

    Definitions
    Bone-anchored hearing aid (BAHA)An alternative to conventional hearing aids when physical or medical complications prevent adequate functional improvement in hearing.
    Definitions
    Mixed hearing lossHearing loss involving impaired bone conduction and/or air conduction, including conductive and sensorineural components.
    Definitions
    Unilateral sensorineural hearing lossSensorineural deafness in one ear with normal hearing in the other ear.
    Definitions
    Policy Summary
    PayerAmbetter Nevada
    PolicyBone-Anchored Hearing Aid
    Policy CodePolicy CP.MP.93
    Change TypeAnnual reviewno material clinical or coverage changes
    Effective DateSep 1, 2026
    Last ReviewMay 1, 2026
    Next Review DateNot specified
    Key ActionFor Medicare members, review all applicable Medicare National and Local Coverage Determinations and Medicare Coverage Articles before applying this policy’s criteria.
    SourceLink
    On This Page
    Medical Necessity RequirementsCodes and Key Coding ThresholdsReview and Denial RisksClinical BackgroundPolicy Definitions
  1. Ineffective air-conduction aid: An air-conduction hearing aid is ineffective because of large conductive hearing loss, including inadequate gain, uncomfortable occlusion, or feedback effects.
    2. Hearing-ear bone-conduction threshold for unilateral deafnessLess than 20 dB
    Replacement Threshold
    Current sound processor ageAt least five years old
  2. For unilateral deafness: hearing-ear bone-conduction threshold <20 dB.
  3. At least one listed clinical indication must be present.
    4. Denial Risk

    Document a qualifying replacement need

    Replacement requests may be denied when the existing device is functional and repairable, no qualifying change in condition makes it inadequate for hearing-related activities of daily living, or the request is solely for convenience or an early technology upgrade.

    • Document that the existing device is no longer functional and cannot be repaired; or
    • Document a change in condition that makes the existing unit inadequate for hearing-related activities of daily living and that improvement is expected with replacement; or
    • Confirm that the current sound processor is at least five years old.
    Denial Risk

    Avoid premature technology upgrades

    Replacement or upgrade requested before the current sound processor is at least five years old is considered not medically necessary when the request is only to obtain newer technology.

    • Do not request replacement solely for convenience or to upgrade to newer technology before the applicable replacement timeframe.
    Note

    Check benefit document limitations

    Coverage decisions are subject to all applicable terms, conditions, exclusions, limitations, and benefit-document provisions, as well as applicable state and federal requirements and Health Plan administrative policies and procedures.

    Health PlanA health plan that has adopted this clinical policy and is operated or administered, in whole or in part, by Centene Management Company, LLC, or one of its affiliates, as applicable.