Bone-Anchored Hearing Aid (BAHA) coverage criteria
Customize your policy alerts
Sign up for Centene Policy CP.MP.93 alerts
Get alerted when Policy CP.MP.93 changes without checking for updates manually.
Monitor payer policy activity
Medical necessity and coverage criteria for implantation, external components, replacements, and upgrades of bone-anchored hearing aids for Centene-affiliated health plans and their members/enrollees.
No material clinical or coverage changes in this revision.
Coverage Criteria
COVERED INDICATIONS
Covered when ALL of the following are met:
ALL of the following
- Implantable device for age ≥ five years; or head band device for age < five years or medically unable to have an implant.
- Unilateral or bilateral conductive and/or mixed hearing loss, or unilateral sensorineural hearing loss, where the condition prevents restoration of hearing using a conventional air-conductive hearing aid.
- Pure tone average bone conduction threshold (measured at 0.5, 1, 2, and 3 kHz) is consistent with the FDA indications for the requested device and an unaided speech discrimination score ≥ 60%.
- For bilateral BAHA, a mean maximum difference < 10 dB between the right and left bone conduction thresholds.
- For unilateral deafness, the hearing ear has a bone conduction threshold of < 20 dB.
One of the following indications:
- Congenital or surgically induced malformations of the ear canal such that it does not exist or cannot accommodate a standard air-conduction hearing aid (provided that the nerve is functional).
- Chronic infection or dermatitis of the middle or outer ear that is exacerbated by a standard air-conduction hearing aid.
- Allergic reactions to standard air-conduction hearing aids.
- Unilateral deafness occurring after removal of an acoustic neuroma, from trauma, from a viral or vascular insult, or from idiopathic causes.
- Tumors of the external canal and/or tympanic cavity.
- Air-conduction hearing aid ineffective due to large conductive hearing loss (inadequate gain, uncomfortable occlusion, and feedback effects).
Replacement/Repair
Replacement/Repair — Replacement or repair of BAHA and/or external components is covered when ANY of the following are met:
ANY of the following
- The existing device(s) is no longer functional and cannot be repaired.
- A change in condition makes the existing unit(s) inadequate for the hearing-related activities of daily living, and improvement is expected with replacement unit(s).
- The current sound processor is at least five years old.
Not Medically Necessary - Upgrades
Not Medically Necessary - Upgrades
ALL of the following
- Replacement or upgrade of an existing, properly functioning bone-anchored hearing aid (BAHA) and/or its external components is considered not medically necessary when requested only for convenience or to simply upgrade to a newer technology before meeting the timeframe noted in the Replacement/Repair criteria.
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 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. |
| 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 bony defect less than 100 sq mm 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 bony 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. |
| 69730 | Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect 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 procedures and devices listed below. Submit PA requests with complete clinical documentation prior to scheduling when possible.
Provider Submission Guidance
Providers should follow the guidance in the full policy and ensure all requested information is included with the authorization submission to avoid delays.
- Include indication, prior device history, and planned procedure
- Attach supporting audiology and clinical notes
Required Clinical Documentation
Documentation must demonstrate that the member meets age and audiometric criteria and include objective test results and prior treatment attempts.
- Age: implantable device for members aged ≥ 5 years; head band device for < 5 years or if medically unable to have an implant
- Audiometry: PTA bone conduction (0.5, 1, 2, 3 kHz) consistent with FDA indications for the device
- Speech discrimination: unaided speech discrimination score ≥ 60%
- For bilateral BAHA: mean maximum difference < 10 dB between right and left bone conduction thresholds
- For unilateral deafness: contralateral (hearing) ear bone conduction threshold < 20 dB
- History: documentation of inability to use or benefit from conventional air-conduction hearing aids (e.g., chronic infection, malformation, allergic reaction, large conductive loss)
- Replacement requests: documentation that the device is nonfunctional/unrepairable, a change in condition makes the current unit inadequate, or the current sound processor is ≥ 5 years old
Denial Risk for Premature Upgrades
Replacement or upgrade requests for a properly functioning BAHA or external components requested solely for convenience or to obtain newer technology before policy timeframes are at high risk for denial.
- Upgrades requested only for convenience are not medically necessary
- Replacement eligibility: device nonfunctional and unrepairable; functional obsolescence only if processor ≥ 5 years or clinical need/change documented
Background
Bone-anchored hearing aids (BAHAs) transmit sound via bone conduction and are indicated for patients with conductive or mixed hearing loss, or with unilateral profound sensorineural hearing loss when conventional air-conduction hearing aids are ineffective or not feasible. Implantable BAHA devices require sufficient skull bone for osseointegration and are typically considered for children aged ≥ 5 years, while non-implant headband or external options may be used for younger children or when implantation is not possible. Skin complications at the implant site are among the most common adverse issues. Replacement or repair of BAHA components is covered when the device is nonfunctional, a change in condition renders the existing unit inadequate with expected improvement after replacement, or when the current sound processor is at least 5 years old.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.