CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

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

Defines coverage and medical necessity criteria for implantable bone‑conduction and bone‑anchored hearing aids for Medicare Advantage and commercial members, including age and indication restrictions.

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 DateJan 12, 2019

Next Review DateN/A

Key ActionFile claims for Commercial Products with the listed ICD‑10 diagnosis codes to be considered medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥5minimum age for commercial coverage

CoveredMedicare Advantage stance

SeveralFDA‑cleared devices

CPT/HCPCSCoding sets

MultipleEvidence syntheses

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage and Medical Necessity Criteria

Covered Indications

Covered when meeting the following plan‑specific criteria:

Medicare Advantage: Implantable bone‑conduction and bone‑anchored hearing aids are covered for Medicare Advantage plans.

CPT/HCPCS coding and member eligibility rules still apply per payer policy.

Commercial medically necessary indications (patients ≥ 5 years): Unilateral or bilateral fully or partially implantable bone‑conduction (bone‑anchored) hearing aid(s) may be considered medically necessary as an alternative to an air‑conduction hearing aid in patients 5 years of age and older with a conductive or mixed hearing loss when one or more of the following is present:age ≥ 5 years

Each bulleted indication below is an OR condition and must be documented.

Clinical indications (OR)

Middle ear disease (eg, chronic conductive pathology)
Chronic external otitis or chronic otitis media
Dermatitis of the external auditory canal preventing use of an air‑conduction aid
Tumor(s) of the external canal and/or tympanic cavity

Commercial indication — single‑sided sensorineural deafness (patients ≥ 5 years): An implantable bone‑conduction hearing aid may be considered medically necessary as an alternative to an air‑conduction contralateral routing of signal (CROS) aid in patients 5 years of age and older with single‑sided sensorineural deafness and normal hearing in the contralateral ear.age ≥ 5 years

Document audiometric confirmation of single‑sided deafness and normal contralateral hearing.

Not Medically Necessary / Insufficient Evidence

Not covered when any of the following apply:

Commercial exclusions / insufficient evidence: Use of implantable bone‑conduction (bone‑anchored) hearing aids for other indications, including treatment of bilateral sensorineural hearing loss, is considered not medically necessary due to insufficient evidence of clinical benefit.

Re‑insertion following non‑medically necessary removal: If initial insertion was determined to be not medically necessary, re‑insertion of the device after removal is also 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 because the evidence is insufficient to determine the effects of the technology on health outcomes. This exclusion applies to indications beyond the specific commercially covered uses described for conductive or mixed losses and single‑sided sensorineural deafness.

When the initial insertion of an implantable bone‑conduction device is determined to be not medically necessary, subsequent re‑insertion after removal of that device is also considered not medically necessary.

Benefits and eligibility for services described in this policy are determined by the member’s subscriber agreement, member certificate, and/or employer agreement; those documents supersede the provisions of this medical policy. For information on member‑specific benefits and eligibility, contact the provider call center.

If services are determined to be not medically necessary (or are medically necessary but are non‑covered benefits under the member’s plan), the provider may not be able to recover payment from the plan and may only bill the member if the member was informed and provided prior written agreement to accept financial responsibility.

Billing and Coding

Covered CPT CodesCPTCovered

69710	Implantation or replacement of electromagnetic bone‑conduction 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
69717	Revision or replacement (including removal of existing device), osseointegrated implant; with percutaneous attachment to external speech processor
69719	Revision or replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor

Covered HCPCS / Supply CodesHCPCSCovered

L8625	External recharging battery for use with cochlear implant or auditory osseointegrated device, replacement only, each system
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
L8624	Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement; each
L8618	Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement

ICD‑10 covered diagnosis codes (Commercial Products only)ICD-10Covered

H60.60
H60.93
H61.301
H61.399
H65.20
H65.499
H66.10
H66.3X9
H90.0
H90.8

1–10 of 12

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Provider Requirements and Operational Notes

Note

Medical criteria

Not applicable

Prior Authorization

Not applicable

Step Therapy

No step therapy requirements are specified for this policy.

Denial Risk

Clinical Background

Hearing loss may be conductive, sensorineural, or mixed and can present as unilateral or bilateral. Bone‑conduction devices transmit sound through the skull to the cochlea and are useful when conventional air‑conduction hearing aids are unsuitable (for example, chronic external otitis, persistent middle ear disease, canal dermatitis, or congenital ear atresia). Implantable bone‑anchored systems include percutaneous devices that use an abutment through the skin and transcutaneous (magnetic) systems that couple internal and external components across intact skin; these systems have been cleared by the FDA for specific indications described elsewhere in this policy.

Key Definitions

CROS (Contralateral routing of signal)

TermCROS (Contralateral routing of signal)

DefinitionMicrophone on the affected ear transmits sound to an air‑conduction (AC) hearing aid on the better ear.

Use stated in policyMay be used as an alternative to an AC hearing aid for individuals with unilateral sensorineural loss.

Percutaneous bone‑anchored system

TermPercutaneous bone‑anchored system

DefinitionImplantable system with an osseointegrated titanium implant in the temporal bone and a percutaneous abutment that permanently protrudes through the skin to connect an external sound processor to the implant.