Blue Cross Blue Shield MA implantable bone‑conduction Coverage

Coverage Criteria for Implantable Bone-Conduction Hearing Devices

Initial implantation — conductive or mixed hearing loss

Covered when ALL of the following are met for individuals 5 years of age and older:

Age and indication: Patient is 5 years of age or older and has conductive or mixed hearing loss or a qualifying medical condition (congenital or surgically induced malformation of the external ear canal or middle ear, tumor of the external canal or tympanic cavity, chronic external otitis or otitis media, or dermatitis of the external canal).age >= 5

Derived from medically necessary indications (chunks 3, 4).

Audiologic criteria: Pure tone average bone-conduction threshold measured at 0.5, 1, 2, and 3 kHz is within device-appropriate limits (examples in policy: ≤55 dB for some devices, ≤65 dB for higher-power devices); for bilateral implantation, interaural bone-conduction difference <10 dB average (0.5,1,2,3 kHz) or <15 dB at individual frequencies.device-specific BC thresholds and symmetry limits

Exact device thresholds and symmetry criteria listed in policy (chunk 4).

Single-sided sensorineural deafness (CROS alternative)

Covered when ALL of the following are met for individuals 5 years of age and older with single-sided deafness:

Age: Patient is 5 years of age or older.age >= 5

(chunk 3)

Normal contralateral hearing: Contralateral (normal) ear has an average air-conduction threshold better than 20 dB measured at 0.5, 1, 2, and 3 kHz.AC <= 20 dB

(chunk 4)

Intended use as CROS alternative: Implantable bone-conduction device is being used as an alternative to contralateral routing of signal (CROS) for single-sided sensorineural deafness.

(chunks 4, 18)

Investigational / insufficient evidence

Not covered / Investigational:

Bilateral sensorineural hearing loss: Use of bone-conduction (bone-anchored) hearing aids in individuals with bilateral sensorineural hearing loss is considered investigational.

(chunk 4)

Uncertain net health benefit for some unilateral SNHL applications: Evidence is insufficient to determine improvement in net health outcome for certain applications (for example, some uses in unilateral sensorineural hearing loss); high-quality randomized controlled trials are lacking and available studies are limited in size and design.

(chunk 18)

Covered with conditions / Insufficient evidence

Summary of coverage considerations from this document segment:

Coverage summary: The evidence for implantable bone‑conduction devices in unilateral sensorineural hearing loss includes small trials and prospective studies that report improvements in patient‑reported outcomes, but systematic review and the limited RCT data do not demonstrate definitive improvement in objective measures (speech recognition, localization). Thus, while BAHA may be considered an alternative to external CROS devices in selected patients not candidates for external devices, overall evidence is insufficient to conclude a net health‑outcome benefit for all unilateral SNHL applications.

Based on summary and evidence statements in the policy (chunk 18).

Use of implantable bone-conduction (bone-anchored) hearing aids in individuals with bilateral sensorineural hearing loss is considered investigational. The policy specifies that other uses outside the outlined indications are investigational and not supported as medically necessary in this document. Evidence cited for single‑sided indications includes small trials and systematic reviews; where evidence is limited or lacks high-quality randomized controlled trials, benefit for other applications has not been established.

Partially implantable systems (transcutaneous/magnetic coupling) are addressed in the policy language alongside fully implantable devices. The document does not list procedural exclusions specific to partially implantable devices; prior policy history noted investigational language for some partially implantable systems that has since been revised. Providers should document device type and prior procedural history when requesting coverage, because device-specific audiologic thresholds and implantation approaches are referenced in the medical necessity criteria.

Other uses of bone-conduction hearing aids beyond the specified medically necessary indications—most notably use in individuals with bilateral sensorineural hearing loss—are explicitly identified as investigational in this policy. The policy further notes that for certain unilateral sensorineural indications the evidence is limited and does not definitively demonstrate a net health benefit.

The policy states that evidence for the use of bone-anchored hearing aids (BAHA) in some cases of unilateral sensorineural hearing loss is insufficient to determine an improvement in net health outcome. Although prospective studies and a pilot randomized trial report improvements in patient-reported outcomes (speech quality, speech perception in noise, satisfaction), a systematic review found no consistent evidence for improved speech recognition or localization, and higher-quality randomized controlled trials are lacking. As a result, coverage for BAHA in unilateral SNHL may be limited to specific circumstances described elsewhere in the policy (for example, when used as a contralateral routing of signal alternative).

Coding and Diagnostic Guidance

Covered CPT CodesCPTCovered

69710	Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone.
69714	Implantation; osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy.
69716	Implantation, 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.
69719	Osseointegrated implant revision or replacement with magnetic transcutaneous attachment to a speech processor.
69726	Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor.
69727	Removal, 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.
69728	Removal, 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.
69729	Implantation, 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.
69730	Replacement (including removal of existing device), 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.

Covered HCPCS CodesHCPCSCovered

L8690

Auditory osseointegrated device — includes all internal and external components.

Example ICD-10 Diagnosis Codes considered medically necessary when criteria metICD-10

C30.1	Malignant neoplasm of middle ear.
C44.201	Unspecified malignant neoplasm of skin of unspecified ear and external auricular canal.
H60.60	Unspecified chronic otitis externa.
H65.23	Chronic serous otitis media, bilateral.
H90.11	Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side.
H90.6	Mixed conductive and sensorineural hearing loss, bilateral.
Q16.1	Other congenital malformations of middle ear.

inv-12: Device-specific bone-conduction thresholds — Pure tone average BC threshold ≤ 55–65 dB depending on device/power.

Pure-tone average BC thresholdDevice-dependent limits: examples in policy include ≤55 dB for some devices, ≤65 dB for others (specific devices cited: Baha 5, Baha 6, Ponto 4/3 Power, Baha 5 SuperPower, Ponto 3 Superpower)

Fitting by device powerThreshold eligibility varies by implant/model and power level (policy lists device-specific examples rather than a single cutoff)

Frequencies used for averagePure-tone average is measured at 0.5, 1, 2, and 3 kHz for bone-conduction thresholds

inv-13: BC symmetry for bilateral implantation — Difference <10 dB average (0.5,1,2,3 kHz) or <15 dB at individual frequencies.

Interaural BC difference (average)For bilateral implantation, difference between left and right bone-conduction thresholds <10 dB on average measured at 0.5, 1, 2, and 3 kHz

Provider Requirements and Prior Authorization

Prior Authorization

Prior Authorization Required

For services described in this policy, precertification/preauthorization is required for all products if the procedure is performed inpatient. Lack of the required precertification/preauthorization when the procedure is performed inpatient may result in claim denial.

Applies to all products when performed inpatient.

Note

Outpatient Prior Authorization Guidance

For outpatient services, prior authorization requirements vary by product. For Commercial PPO and Indemnity, Medicare HMO Blue, and Medicare PPO Blue, prior authorization is not required for outpatient procedures under this policy. Providers should verify product-specific outpatient prior authorization requirements prior to scheduling.

Commercial PPO and Indemnity: Outpatient prior authorization is not required.
Medicare HMO Blue: Outpatient prior authorization is not required.
Medicare PPO Blue: Outpatient prior authorization is not required.

Background on Implantable Bone-Conduction Devices

Implantable bone-conduction devices transmit sound via skull bone conduction to the cochlea and are indicated primarily for conductive or mixed hearing loss and for single-sided sensorineural deafness when used as an alternative to contralateral routing of signal (CROS). These systems include fully implantable and partially implantable (transcutaneous magnetic coupling) devices; partially implantable systems avoid a percutaneous abutment by using magnetic coupling between implanted and external components. Device candidacy depends on audiologic thresholds and device-specific power limits.

Definitions

inv-25: Definition — Pure-tone average description (averaging thresholds across frequencies).

DefinitionPure-tone average is calculated by averaging hearing sensitivities (the minimum volume a patient hears) at multiple frequencies, typically within the range of 0.25 to 8 kHz.

UseUsed to categorize degree of hearing loss (eg, normal ≤20 dB; mild 20–40 dB; moderate 40–60 dB; severe 60–80 dB)

MeasurementPure-tone average commonly uses thresholds from several frequencies (policy uses 0.5, 1, 2, and 3 kHz for relevant criteria)

inv-26: Definition — Transcutaneous (magnetic) bone-conduction system description.

DescriptionA partially implantable system in which acoustic transmission occurs transcutaneously via magnetic coupling between the external sound processor and internally implanted components (no percutaneous abutment).

Skin consideration

OpenPayer

Implantable Bone‑Conduction (Bone‑Anchored) Hearing Aids — Coverage Criteria

Coverage Criteria for Implantable Bone-Conduction Hearing Devices

Coding and Diagnostic Guidance

Provider Requirements and Prior Authorization

Background on Implantable Bone-Conduction Devices

Definitions