Implantable Bone-Conduction (Bone-Anchored) Hearing Aids — Coverage Criteria
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This policy governs coverage and coding for implantable bone-conduction (bone-anchored) hearing aids for Medicare Advantage and commercial products, including indications, age limits, and device types.
No material clinical or coverage changes in this revision.
Coverage Criteria
Commercial Medical Necessity Criteria
Covered when ALL of the following are met for patients 5 years and older
FDA-cleared indications listed in policy
These indications are listed as qualifying conditions for an implantable bone-conduction hearing aid.
Medicare Advantage Coverage
Medicare Advantage
Refer to coding section for allowable CPT/HCPCS codes and billing guidance.
Use of implantable bone-conduction (bone-anchored) hearing aids in patients with bilateral sensorineural hearing loss and other uses not specifically listed in the coverage indications are not medically necessary. The policy states that evidence is insufficient to determine effects on health outcomes for those uses and they therefore fall outside covered indications.
When the initial insertion of an implantable bone-conduction device is determined to be not medically necessary, any subsequent re-insertion of the device after removal is also considered not medically necessary.
Benefits, eligibility, and payment determinations are governed by the member's subscriber agreement, member certificate, and/or employer agreement; those documents supersede the provisions of this medical policy. For member-specific benefit information, providers should contact the provider call center.
Other uses of implantable bone-conduction (bone-anchored) hearing aids, including implantation for patients with bilateral sensorineural hearing loss, are considered not medically necessary because the evidence is insufficient to determine effects on health outcomes.
If services are determined to be not medically necessary (or are medically necessary but not covered under the member's benefit plan), the provider may not charge the member for those services unless the member was informed in advance and agreed in writing to accept financial responsibility.
Coding and Billing Codes
| 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 |
| 69715 | Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy (Code deleted 12/31/2021) |
| 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 |
| L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each |
| H60.60 - H60.93 | External ear infection/conditions range |
| H61.301 - H61.399 | Disorders of external ear range |
| H65.20 - H65.499 | Non-suppurative otitis media range |
| H66.10 - H66.3X9 | Suppurative and unspecified otitis media range |
| H90.0 - H90.8 | Conductive and sensorineural hearing loss range |
| Q16.0 - Q16.9 | Congenital malformations of ear range |
| L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
| L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
Provider Actions and Billing Guidance
Prior Authorization
Prior Authorization: Not applicable.
Verify Benefits and Eligibility
Benefit coverage and eligibility may vary between groups/contracts. Providers must check the member's Benefit Booklet, Evidence of Coverage, Subscriber Agreement, or employer agreement for applicable surgery benefits, coverage limitations, and whether a particular service is a covered benefit for that member.
Claims Coding Requirement for Commercial Products
Commercial Products — Claims for Commercial Products require the CPT and HCPCS codes listed in the policy to be filed with the ICD-10 diagnosis codes enumerated for Commercial Products. Submissions with other diagnosis codes are not medically necessary and are subject to denial.
Not Medically Necessary Uses
Clinical Indications and Limitations: Implantable bone-conduction (bone-anchored) hearing aids are considered not medically necessary for use in patients with bilateral sensorineural hearing loss. Use for bilateral sensorineural hearing loss or other uses not listed as medically necessary in this policy will be denied.
Payment and Authorization Disclaimer
Payment and Authorization Disclaimer: This medical policy is informational only and is not a guarantee of payment. Benefits and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement, which supersede this policy. For member-specific benefits or coverage determinations, contact the provider call center or refer to the member's documents.
Member Liability for Non‑Covered or NMN Services
Member Liability When Services Are Non‑Covered or Not Medically Necessary: If services provided are determined to be not medically necessary (or are medically necessary but are non‑covered benefits), providers may not bill the member unless the provider informed the member in advance and the member agreed in writing to accept financial responsibility. Refer to your participation agreement for applicable provisions.
Background
Implantable bone-anchored hearing systems transmit sound via bone conduction and are used as alternatives to external air-conduction (AC) or external bone-conduction hearing aids for patients with conductive or mixed hearing loss or for single-sided sensorineural deafness. Devices may be fully or partially implantable and can be percutaneous (abutment) or transcutaneous (magnetic coupling); the technology relies on osseointegration to transmit sound through the skull to the cochlea.
Definitions
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