CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Implantable bone-conduction (bone-anchored) hearing aids — Coverage Criteria

This policy governs coverage and medical necessity criteria for implantable bone-conduction (bone-anchored) hearing aids for Blue Cross Blue Shield - Rhode Island commercial products and BlueCHiP for Medicare, including indications, age thresholds, and coding guidance for providers.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyImplantable bone-conduction (bone-anchored) hearing aids — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective DateDec 1, 2019

Next Review DateN/A

Key ActionVerify member-specific benefits and prior authorization requirements via the provider call center or benefit documents before providing services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

ages 5+minimum FDA-cleared age

2019-12-01effective date

2020-11-07last updated

multiplebilling codes

Coverage and Medical Necessity Criteria

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Commercial medical necessity indications

Covered when ALL of the following are met for Commercial Products:

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

FDA-cleared age limit

Indications for conductive or mixed hearing loss: Presence of one of: congenital or surgically induced malformations (eg, atresia) of the external ear canal or middle ear; chronic external otitis or otitis media; tumors of external canal and/or tympanic cavity; dermatitis of the external canal

Implantable bone-conduction hearing aid considered alternative to air-conduction hearing aid

Single-sided deafness indication

Covered when ALL of the following are met for single-sided sensorineural deafness:

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

FDA-cleared age limit

Hearing status: Single-sided sensorineural deafness with normal hearing in the contralateral ear

Implantable BAHA may be considered as alternative to air-conduction CROS hearing aid

Not Medically Necessary

Not covered / Not medically necessary:

Excluded uses: Use in patients with bilateral sensorineural hearing loss and other uses not listed are considered not medically necessary

Evidence insufficient to determine health outcomes

Device reinsertion: Re-insertion of the device after removal when the initial insertion was not medically necessary

Considered not medically necessary

Other uses of implantable bone-conduction (bone-anchored) hearing aids, including use in patients with bilateral sensorineural hearing loss, are considered not medically necessary. The policy states that the evidence is insufficient to determine the effects of the technology on health outcomes for these uses, and therefore they are excluded from coverage.

If services are determined to be not medically necessary (or are medically necessary services that are non-covered benefits), the member may not be charged for those services unless the member was informed in advance and agreed in writing to continue the treatment at their own expense. Benefits and eligibility are determined by the member’s subscriber agreement, member certificate, or employer agreement; providers should contact the provider call center for member-specific benefit information.

Re-insertion of an implantable bone-conduction device after removal is considered not medically necessary when the initial insertion itself was not medically necessary. This policy explicitly denies coverage for re-insertion in such situations.

Services determined to be not medically necessary are cited as potential grounds for denial or non-coverage. The policy requires that members cannot be billed for such services unless they were informed and provided written consent in advance; specific administrative or appeals procedures are not provided in this excerpt.

CPT, HCPCS and Diagnosis Codes

Covered CPT CodesCPTCovered

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, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
69715	Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
69717	Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment; without mastoidectomy
69718	Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment; with mastoidectomy

Covered HCPCS CodesHCPCSCovered

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
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

Commercial Products ICD-10 covered diagnosis codesICD-10Covered

H60.60 - H60.93	External ear conditions (range listed)
H61.301 - H61.399	Other external ear disorders (range listed)
H65.20 - H65.499	Non-suppurative otitis media and related codes (range listed)
H66.10 - H66.3X9	Suppurative and unspecified otitis media (range listed)
H90.0 - H90.8	Conductive and sensorineural hearing loss codes (range listed)
Q16.0 - Q16.9	Congenital malformations of ear (range listed)

Provider Responsibilities, Billing & Authorization

Prior Authorization

Prior authorization and covered procedure codes

Prior authorization: Not applicable for this policy. However, for BlueCHiP for Medicare and for Commercial products, specific CPT/HCPCS procedure codes listed below are covered when billed with the authorized ICD‑10 diagnosis codes (Commercial only). Providers should verify whether prior authorization is required for the member's product prior to performing services.

Covered CPT/HCPCS codes must be filed with the applicable ICD-10 diagnosis codes for Commercial Products; otherwise services are not medically necessary.
BlueCHiP for Medicare: CPT and HCPCS codes listed in the policy are covered.
When billing Commercial Products use the ICD-10 codes listed in the policy (see ICD-10 covered diagnosis codes for Commercial Products only).

Note

Prior authorization and benefit verification

This policy is informational and benefits may vary by contract. Providers must verify member-specific benefits, eligibility, and any prior authorization requirements with the payer (provider call center) before delivering services.

Benefits and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement and those documents supersede this policy.
Contact the provider call center for member-specific benefit and prior authorization information.

Denial Risk

Not medically necessary uses

Use of implantable bone-conduction (bone-anchored) hearing aids for indications not listed as medically necessary (including use in patients with bilateral sensorineural hearing loss) is considered not medically necessary and will be denied.

Not medically necessary for bilateral sensorineural hearing loss and other uses not listed as medically necessary.
Re-insertion of a device after removal is not medically necessary when the original insertion was not medically necessary.

Denial Risk

Member financial liability and denial risk

If services are determined to be not medically necessary (or are medically necessary services that are non‑covered benefits), providers may not charge the member unless the member has been informed in advance and has agreed in writing to pay. Providers should refer to participation agreements for applicable provisions.

Do not bill members for services determined not medically necessary unless there is documented, written member consent to pay in advance.
Verify member-specific coverage to determine potential member financial liability.

Documentation Required

Benefit verification required

Benefits and coverage limits vary by group/contract. Providers must refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable surgery benefits, coverage limitations, and for guidance when services are not medically necessary.

Refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for coverage limits and surgery benefit details.
Confirm any applicable preauthorization, prior notification, or filing requirements per the member's contract.

Background and Clinical Rationale

Implantable bone-anchored hearing aids transmit sound via bone conduction and may be indicated for conductive or mixed hearing loss (for example, congenital or surgically induced ear canal/middle ear malformations, chronic external otitis or otitis media, tumors of the external canal or tympanic cavity, or dermatitis of the external canal). They may also be used as an alternative to an air-conduction contralateral routing of signal (CROS) hearing aid for patients with single-sided sensorineural deafness and normal hearing in the contralateral ear. FDA-cleared devices are available for patients aged 5 years and older.

Key Definitions

inv-21: Contralateral routing of signal (CROS)

DefinitionA system in which a microphone on the affected side transmits a signal to a hearing aid on the normal or less affected side.

Use caseUsed as an alternative to an air-conduction (AC) hearing aid for unilateral (single-sided) sensorineural hearing loss when AC aids are unsuitable.

Relation to BAHACan be implemented with implantable bone-anched systems (BAHAs) to provide contralateral routing when AC devices are not appropriate.

inv-22: Pure-tone average (PTA)

DefinitionAverage of hearing sensitivities at multiple frequencies (typically 0.25 to 8 kHz) used to classify degree of hearing loss.

PTA thresholds (ASHA)Mild: 20–40 dB; Moderate: 40–60 dB; Severe: 60–80 dB; Profound: ≥80 dB.

CalculationPTA is calculated by averaging the minimum volume the patient hears across the specified frequencies (pure-tone detection thresholds).

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