CurrentCentenePolicy CP MP.93

Bone-Anchored Hearing Aid (BAHA) Coverage Criteria

Defines medical necessity, replacement, and coding guidance for implantable and non-implantable bone-anchored hearing aids for Centene-affiliated health plans; applies to providers requesting coverage for members seeking BAHA implantation, replacement, or external components.

Policy Summary

PayerCentene

PolicyBone-Anchored Hearing Aid (BAHA) Coverage Criteria

Policy CodePolicy CP MP.93

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain prior authorization and document clinical indications, audiometric results including pure tone average bone conduction thresholds and unaided speech discrimination score when requesting implantation or replacement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

age ≥ 5min implant age

≥ 60%speech discrim.

<10 dBbilateral threshold diff

≥ 5 yrsprocessor replacement

L8690-L8694HCPCS range

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Coverage and Medical Necessity Criteria

BAHA initial implantation candidacy

Covered when ALL of the following are met:

Indication types: 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-conduction hearing aid.

Includes cases where ear canal malformation, chronic infection, dermatitis, allergic reactions, tumors, or other causes prevent use of conventional aids.

Audiometric criteria: Pure tone average bone conduction threshold (measured at 0.5, 1, 2, and 3 kHz) consistent with the FDA indications for the requested device AND unaided speech discrimination score ≥ 60%.PTA per device FDA indications; speech discrimination ≥ 60%

For bilateral implantation, mean maximum difference between right and left bone conduction thresholds must be < 10 dB.

Age or alternative device: Implantable device for age ≥ 5 years; headband/softband device for age < 5 years or when medically unable to have an implant.age ≥ 5 for implant

Children are usually around six years before implantable BAHA is feasible due to need for 3–4 mm of skull bone for osseointegration.

Specific clinical indications: One of the following: congenital or surgically induced malformation of the ear canal such that a standard air-conduction hearing aid cannot be used (provided the nerve is functional); chronic infection or dermatitis of the middle or outer ear exacerbated by a standard air-conduction hearing aid; allergic reactions to standard air-conduction hearing aids; tumors of the external canal and/or tympanic cavity; unilateral deafness (including post-acoustic neuroma removal, trauma, viral/vascular insult, or idiopathic causes); or air-conduction hearing aid ineffective due to inadequate gain, uncomfortable occlusion, or feedback.

For unilateral deafness, the hearing ear should have a bone conduction threshold ≤ 20 dB.

Replacement of BAHA and external components

Replacement and upgrades

Replacement criteria: Replacement of BAHA and/or external components is medically necessary when any of the following are met: the existing device(s) is no longer functional and cannot be repaired; a change in condition makes the existing unit(s) inadequate for hearing-related activities of daily living and improvement is expected with replacement; or the current sound processor is at least five years old.processor age ≥ 5 years

Replacement or upgrade of a properly functioning device requested only for convenience or to obtain newer technology before the timeframe noted (e.g., before 5 years for processors) is considered not medically necessary.

Replacement or upgrade of a properly functioning bone-anchored hearing aid (BAHA) and/or its external components requested solely for convenience or to obtain newer technology before the timeframe specified in this policy is considered not medically necessary. Requests to replace a functioning implant or external sound processor only to upgrade to more recent features or models do not meet coverage criteria.

Replacement of a BAHA and/or external components may be considered medically necessary only when one or more of the following apply: the existing device is nonfunctional and cannot be repaired; there has been a change in the patient’s condition that makes the existing unit inadequate for hearing-related activities of daily living and improvement is expected with replacement; or the current external sound processor is at least five years old. Conversely, replacement or upgrade requests submitted before these conditions are met may be denied as not medically necessary.

Coding, Thresholds, and Key Values

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, 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 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 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.

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Covered HCPCS CodesHCPCSCovered

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.

inv-07: Unaided speech discrimination score — candidacy threshold

ThresholdUnaided speech discrimination score ≥ 60%

DefinitionPercentage score of speech understanding without hearing aid amplification

Measurement contextMeasured unaided (without amplification) as part of audiometric evaluation; required for candidacy

inv-08: Hearing ear bone conduction threshold for unilateral deafness — numeric threshold

ThresholdHearing ear bone conduction threshold ≤ 20 dB

ContextRequired for members with unilateral deafness

MeasurementPure tone average bone conduction thresholds measured at 0.5, 1, 2, and 3 kHz

inv-09: Bilateral bone conduction threshold difference — numeric threshold

ThresholdMean maximum difference between right and left bone conduction thresholds < 10 dB

ApplicabilityRequired for bilateral BAHA candidacy

MeasurementBased on pure tone bone conduction thresholds

Prior Authorization, Documentation, and Billing Actions

Denial Risk

Replacement convenience denial risk

Replacement or upgrade requests for a properly functioning BAHA or external sound processor submitted solely for convenience or to obtain newer technology before the timeframes below are at high risk for denial. Replacement is considered medically necessary only when criteria are met (device nonfunctional/unrepairable; change in condition making the current unit inadequate with expected improvement from replacement; or current sound processor is at least five years old).

Denial risk applies when the existing device is functioning and the request is for convenience or early technology upgrade.
Replacement is medically necessary when: device is nonfunctional and cannot be repaired; a change in clinical condition makes the current unit inadequate with expected improvement from replacement; or the current external sound processor is ≥ 5 years old.

Documentation Required

Required documentation for medical necessity

Providers must submit documentation to support medical necessity at the time of prior authorization. Documentation should clearly demonstrate the diagnostic findings and clinical indications that justify an implantable BAHA or use of a non-implantable alternative when implant is not appropriate.

Audiometric testing results, including pure tone average bone conduction thresholds (0.5, 1, 2, and 3 kHz) and unaided speech discrimination score.
Clinical history and findings supporting one of the policy indications (e.g., congenital canal atresia, chronic infection/dermatitis, allergic reaction to air-conduction aids, tumor of the external canal/tympanic cavity, unilateral deafness due to specified causes).
Explanation why conventional air-conduction hearing aids are inadequate (e.g., ineffective due to conductive loss, feedback, occlusion, inadequate gain).
For bilateral BAHA: documentation of mean maximum difference < 10 dB between right and left bone conduction thresholds.
For unilateral deafness: documentation the hearing ear has a bone conduction threshold ≤ 20 dB.
Operative reports, device history, and repair attempts if replacing a prior device.

Prior Authorization

Non-implantable device use prior to implant

When implant surgery is not feasible (for example, in young children or medically ineligible patients), non-implantable external devices such as headbands or softbands may be used prior to implantation. Providers should document age or medical contraindication and device type used.

Non-implantable options (e.g., headband/softband) are appropriate for children typically under the age required for implantation (commonly around 5–6 years) or when there is insufficient bone for osseointegration.
Use of L8692 for body-worn/headband auditory osseointegrated devices when billed as non-implantable.
Document reason for non-implantable use (age, insufficient bone, or other medical ineligibility) and audiometric benefit demonstrated with the non-implantable processor prior to implant consideration.

Billing Rule

Procedure and device codes requiring prior authorization

Certain procedure and device codes listed in the policy require prior authorization. Include clinical documentation with the PA request and follow billing guidance for replacement-only HCPCS codes.

Relevant CPT codes (examples): 69710, 69711, 69714, 69716, 69717, 69719, 69726–69730 (implantation, removal, replacement procedures).
Relevant HCPCS codes for devices/components: L8690 (auditory osseointegrated device — internal and external components), L8691 (external sound processor — replacement only), L8692 (external sound processor used without osseointegration; headband/body-worn), L8693 (abutment replacement), L8694 (transducer/actuator replacement).
When submitting replacement claims, use the replacement-specific HCPCS (e.g., L8691, L8693, L8694) and include prior authorization documentation demonstrating the replacement meets medical necessity criteria.

Definitions

inv-15: BAHA — definition of bone-anchored hearing aid and components

DefinitionBone-anchored hearing aid (BAHA) — an implantable titanium osseointegrated device surgically inserted into the skull and attached to an abutment that couples a removable external sound processor to transmit sound via bone conduction

Primary componentsTitanium implant, abutment (percutaneous or magnetic/transcutaneous), and removable external sound processor

FunctionTransmits sound directly through the skull bone to the inner ear, improving auditory acuity for conductive, mixed, or single-sided sensorineural hearing loss

inv-16: Unaided speech discrimination score — definition and its required threshold

DefinitionUnaided speech discrimination score — the percentage score of speech understanding without hearing aid amplification

Required thresholdPolicy requires unaided speech discrimination score ≥ 60% for BAHA candidacy

Association with audiometryDocumented as part of audiometric evaluation alongside pure tone average bone conduction thresholds (0.5, 1, 2, 3 kHz)

OpenPayer

Bone-Anchored Hearing Aid (BAHA) Coverage Criteria

Coverage and Medical Necessity Criteria

Coding, Thresholds, and Key Values

Prior Authorization, Documentation, and Billing Actions

Background

Definitions