Bone-Anchored Hearing Aid
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Defines medical necessity, replacement criteria, and coding guidance for implantable and headband bone-anchored hearing aids for members of Centene-affiliated health plans.
Updated criteria I.C. to specify consistency with the FDA indications for the requested device.
Added criteria to I.B. 'where the condition prevents restoration of hearing' for candidacy.
Added (provided that the nerve is functional) to indication for congenital or surgically induced malformations.
Coverage Criteria
Initial Candidacy
Covered when ALL of the following are met:
implant typically feasible around 6 years due to bone thickness
added requirement that condition prevents restoration of hearing
criteria I.C. updated to reference FDA indications
items listed in policy section I.F
Replacement / Upgrade Criteria
Replacement of BAHA and/or external components is covered when ANY of the following are met:
covered replacement
covered replacement
replacement considered medically necessary
Not Medically Necessary Conditions
considered not medically necessary
Replacement or upgrade requests for bone-anchored hearing aids (BAHA) and/or external components are assessed against the policy's replacement criteria. Covered replacements include situations where the existing device is non-repairable, a change in clinical condition renders the current unit inadequate for hearing-related activities of daily living with expected improvement after replacement, or the current external sound processor has reached at least five years of use. Prior authorization is required for implantation, replacement, removal, and external processor billing using the CPT and HCPCS codes listed in the policy.
Replacement or upgrade requests that are made solely for convenience or to obtain newer technology before the replacement timeframe are considered not medically necessary. Specifically, upgrades requested when the current sound processor is younger than five years may be denied.
Coding and Clinical Thresholds
| 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 sqmm 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. |
| 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 defect less than 100 sqmm 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 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. |
| L8690 | Auditory osseointegrated device — includes all internal and external components. |
| L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each. |
| L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration; body worn, includes headband or other means of external attachment. |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only. |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each. |
Provider Actions and Requirements
Prior Authorization Required
Prior authorization is required for implantation, replacement, removal, and external sound processor billing for bone-anchored hearing devices.
Denial Risk for Premature Upgrades or Convenience Replacements
Replacement or upgrade requests for a properly functioning BAHA or external sound processor requested solely for convenience or to obtain newer technology before the timeframe specified in policy are considered not medically necessary and may be denied.
- Replacement is considered medically necessary only when existing device is nonfunctional and cannot be repaired; there is a change in condition making the existing unit inadequate and improvement is expected with replacement; or the current sound processor is at least five years old.
- Requests for upgrades solely for convenience or to obtain newer technology before 5 years (or before demonstrating device failure/inadequacy) carry denial risk.
Required Clinical Documentation
Submit documentation demonstrating device selection, audiologic test results, and clinical indications to support medical necessity.
- Audiologic documentation: pure tone bone-conduction thresholds (0.5, 1, 2, and 3 kHz) and unaided speech discrimination score (≥ 60%)
- Clinical indications: congenital or surgically induced ear canal malformation preventing use of air-conduction aid; chronic infection/dermatitis exacerbated by air-conduction aid; allergic reaction to air-conduction aid; tumors of external canal/tympanic cavity; unilateral deafness due to acoustic neuroma removal, trauma, viral/vascular insult, or idiopathic causes; or air-conduction aid failure due to inadequate gain/feedback/occlusion
Provider Billing and Claims Actions
Follow billing and claims instructions to ensure correct coding and reimbursement for implantation, removal, replacement, and external processor transactions.
- Use the appropriate CPT for surgical procedures (e.g., 69710–69730 series) and HCPCS L-codes for devices and external processors (L8690–L8694).
- When billing for replacement-only external processors, use the replacement-specific HCPCS (e.g., L8691, L8693, L8694 where applicable).
- If device is repaired rather than replaced, report removal/repair codes (e.g., 69711) as appropriate and include documentation of repair attempts.
Background
A bone-anchored hearing aid (BAHA) transmits sound via bone conduction and may be provided as an implantable osseointegrated device with an abutment and external processor or as an external headband-style processor when implantation is not feasible. Implantable BAHA devices are typically feasible when skull bone thickness permits (commonly around age six), while headband devices can be used at younger ages or when an implant is not possible. Skin care around the abutment is important to avoid complications, and BAHA is indicated when conventional air-conduction hearing aids cannot restore hearing in conductive or mixed hearing loss or in single-sided sensorineural deafness.
Definitions
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