Implantable Bone-Anchored Hearing Aids (BAHA)
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This policy covers medical necessity, coverage stance, and coding for implantable bone-conduction and bone-anchored hearing aids for Medicare Advantage and commercial product members, including indications and age limits.
No material clinical or coverage changes in this revision.
Coverage and Medical Necessity
Coverage and Medical Necessity
Covered when ALL of the following are met:
Use of implantable bone-conduction (bone-anchored) hearing aids is limited by indication. For commercial products, these devices may be considered medically necessary in patients 5 years of age and older with conductive or mixed hearing loss when one or more of the following apply: congenital or surgically induced malformations of the external ear canal or middle ear (eg, atresia); chronic external otitis or otitis media; tumors of the external canal and/or tympanic cavity; or dermatitis of the external canal. An implantable bone-conduction device may also be considered medically necessary as an alternative to an air-conduction CROS hearing aid for patients 5 years of age and older with single-sided sensorineural deafness and normal hearing in the contralateral ear. Other indications (for example, use in patients with bilateral sensorineural hearing loss) lack sufficient evidence and are considered not medically necessary. Re-insertion of a device after removal is considered not medically necessary when the original insertion was not medically necessary.
Coverage and payment for services described in this policy depend on the member’s subscriber agreement, member certificate, or employer agreement, which take precedence over this policy. For member-specific benefits and eligibility, contact the provider call center. Providers should confirm benefit limitations, prior authorization requirements (if any), and member cost-sharing before scheduling services.
Other uses of implantable bone-conduction hearing aids are considered investigational or unproven when evidence is insufficient to determine effects on health outcomes. Specifically, use in patients with bilateral sensorineural hearing loss is considered not medically necessary because the available studies do not adequately demonstrate clinical benefit compared with alternatives.
Services that are determined to be not medically necessary under this policy, or services that are categorized as non-covered per the member’s contract, may not be paid. Providers may not bill the member for such services unless the member was informed in advance and provided written agreement to self-pay. Refer to participation agreements and the member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable provisions.
Procedure and Device Coding
| 69710 | Implantation or replacement of electromagnetic bone-conduction hearing device in temporal bone. |
| 69711 | Removal or repair of electromagnetic bone conduction hearing device in temporal bone. |
| 69714 | Implantation, osseointegrated implant, skull with percutaneous attachment to external speech processor. |
| 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. |
| 69717 | Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor. |
| 69719 | Replacement (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 deep to the outer cranial cortex. |
| 69729 | Implantation, osseointegrated implant, skull; with attachment to external speech processor, outside of the mastoid. |
| 69730 | Replacement osseointegrated implant, skull; with attachment to external speech processor, outside the mastoid. |
| L8625 | External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each. |
| L8690 | Auditory osseointegrated device, includes all internal and external components. |
Provider Requirements and Billing Guidance
Prior Authorization and Benefit Verification
Prior authorization requirements vary by contract. Verify prior authorization and benefit coverage before scheduling services.
- Confirm prior authorization per subscriber agreement or plan-specific requirements
- Contact provider call center for member-specific benefit and eligibility verification
Benefit Verification
Verify member benefits and eligibility in the member's Benefit Booklet / Evidence of Coverage / Subscriber Agreement. Benefits and coverage may differ between groups/contracts; contact the provider call center for member-specific information and document all determinations.
- Refer to member Benefit Booklet / EOC / Subscriber Agreement for coverage details
- Document benefit verification and any verbal or written agreements with the member
Member Financial Responsibility Risk
If services are not medically necessary or are non-covered, the member may be financially responsible for charges only if informed in advance and they provide written agreement to proceed at their own expense. Refer to your participation agreement for applicable provisions.
- Obtain and retain written member agreement before providing services determined to be not medically necessary or non-covered if member will be charged
- Failure to obtain documented agreement may result in denied payment and provider liability for member charges
Diagnosis-dependent Coverage and Coding
For Commercial Products, coverage of CPT/HCPCS codes is diagnosis-dependent; ensure claims are filed with the appropriate ICD-10 diagnosis codes that meet medical necessity criteria.
- File claims with supporting ICD-10 diagnosis codes for Commercial members to avoid denials
- Refer to the Coding section for specific CPT/HCPCS codes and associated diagnosis requirements
Prior Authorization and Subscriber Agreement
Prior authorization and benefit determination are subject to the member's subscriber agreement. Always verify and document authorization and coverage before proceeding.
- Obtain prior authorization when required by the subscriber agreement
- Document the subscriber agreement or employer agreement terms that govern coverage
Clinical Background
Hearing loss is classified as conductive, sensorineural, or mixed, and may be unilateral or bilateral. It is commonly quantified using pure-tone averages to determine the degree of hearing impairment. Implantable bone-anchored hearing aids transmit sound through bone conduction and are used when air-conduction hearing aids are not appropriate. These systems may be percutaneous (with an abutment) or transcutaneous (magnetically coupled or active transcutaneous systems); observational studies report within-subject improvements in hearing and functional outcomes after implantation for conductive or mixed loss, supporting their use in appropriately selected patients.
Key Definitions
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