ModifiedPremera BluecrossPolicy 7.01.547

Implantable Bone-Conduction and Bone-Anchored Hearing Aids

Defines medical necessity, age considerations, and coverage criteria for implantable and non-implanted bone-conduction (bone-anchored) hearing aids and related components for Premera members.

Policy Summary

PayerPremera Bluecross

PolicyImplantable Bone-Conduction and Bone-Anchored Hearing Aids

Policy CodePolicy 7.01.547

Change TypeCriteria additions and coding updates

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization when the plan requires it and document otolaryngologist clearance for minors within the preceding six months.

SourceLink

POLICY UPDATE CHANGES

Added coverage criteria for minors under 18 years of age.

Added CPT code 69719 effective August 1, 2025 following 90-day provider notification.

Added medical necessity criteria for the ADHEAR non-invasive bone conduction hearing device.

Reinstated criteria for transcutaneous BAHA with Softband.

Benefit Application updated to include new WA Mandate effective January 1, 2026.

5 yearsminimum age for surgical implantation to be considered medically necessary

under 5non-implanted use medically appropriate for

≤45/≤55/≤65device-specific PTA limits cited

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.

WA mandate interval for hearing instruments

2026-01-01WA mandate effective

Coverage Criteria for Bone-Conduction Hearing Devices

Replacement parts and upgrades

Replacement parts and upgrades, Medical Necessity =

Replacement parts or upgrades to existing bone-conduction (bone-anchored) or transcutaneously worn hearing aid components (e.g., batteries, processor, headband, or adhesive adapter) are considered medically necessary for individuals whose response to the device is inadequate or when components are no longer functional and cannot be repaired.

Replacement parts or upgrades are considered medically necessary when they are required to maintain appropriate device function for a device that previously met medical necessity criteria for the individual.

Replacement parts or upgrades are considered NOT medically necessary when any of the following apply:

• The above medically necessary criteria for the device (implantable or transcutaneous) have not been met.

• The parts or upgrades are requested solely for the convenience of the individual (e.g., cosmetic changes, nonessential accessories).

• The request is for an upgrade to newer technology when the current components remain functional and serviceable.

Note: See Reasonable Useful Life Expectancy for BAHA Parts below for guidance on expected replacement intervals and benefit administration.

Coding and Device Identifiers

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 in temporal bone.
69714	Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy.
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.
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.

Covered HCPCS CodesHCPCSCovered

L8690	Auditory osseointegrated device, includes all internal and external components.
L8691	Auditory osseointegrated device, external sound processor, replacement.
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.

FDA 510(k) clearances citedmixed

K212136	510(k) No. for Baha 6 System (Cochlear Americas)
K182116	510(k) No. for BA310 Abutment/BIA310 Implant/Abutment
K161123	510(k) No. for Baha 5 Power Sound Processor
K153245	510(k) No. for Baha 5 Super Power Sound Processor
K042017	510(k) No. for Baha Divino
K081606	510(k) No. for Baha Intenso
K132278	510(k) No. for Baha 4 (upgraded from BP100)
K142907	510(k) No. for Baha 5 Sound Processor
K131240	510(k) No. for Baha Attract System
K150751	510(k) Nos. for Baha Cordelle II (includes K080363)

1–10 of 21

1/3

FDA product codesmixed

LXB	FDA product code for bone-anchoring hearing aid
MAH	FDA product code for implanted bone-conduction hearing aid

Policy-tracked CPT/HCPCS codesmixed

69716	CPT code added to policy (description updated)
69717	CPT code description updated
69719	New CPT code added effective August 1, 2025
69729	CPT code added
69730	CPT code added
L8692	HCPCS code added
L8694	HCPCS code added previously
L8625	HCPCS code removed (noted removed in 05/01/25 history)

inv-21: Pure tone average bone-conduction threshold — device-specific limits (examples) measured at 0.5, 1, 2, and 3 kHz

MeasurementPure-tone average bone-conduction threshold measured at 0.5, 1, 2, and 3 kHz (same as 500, 1000, 2000, 3000 Hz)

Device examples & unilateral limitsOBC and BP100: ≤ 45 dB; Intenso: ≤ 55 dB; Cordelle II: ≤ 65 dB

Device-specific bilateral use noteBetween-ear difference criteria for bilateral use commonly specified as ≤10 dB (average) or ≤15 dB at individual frequencies for many devices

Reference to TableSee Table 1 for manufacturer's recommended hearing loss thresholds and device-specific notes

inv-22: Skin thickness over implant — guidance to reduce to 4-5 mm for transcutaneous magnetic transmission

Provider Actions, Documentation & Prior Authorization

Prior Authorization

Prior Authorization & Benefit Verification

Prior authorization may be required by the health carrier; failure to obtain prior authorization when required could result in claim denial.

Prior authorization may be required — verify with Premera prior to scheduling.
Coverage depends on the member’s benefit booklet and plan type; this policy does not apply to Medicare Advantage.
For non-grandfathered group plans in WA issued or renewed on/after 2026-01-01, coverage and utilization controls follow the WA Mandate.

Step Therapy

No step therapy requirements are described in this policy. Providers should still verify applicable utilization controls with the health plan.

No step therapy requirements described in these policy sections.

Background and Rationale

Bone-conduction (bone-anchored) hearing aids provide an alternate sound pathway that bypasses the outer and middle ear by transmitting vibrations through the skull bone directly to the inner ear. These systems may be external (non-implanted) such as headband or Softband processors or adhesive systems, or surgically implanted as osseointegrated devices with percutaneous or magnetic transcutaneous coupling to an external processor. The devices are intended for individuals with conductive or mixed hearing loss or for selected candidates with single-sided sensorineural deafness when criteria are met; device-specific age and audiologic thresholds apply for implantation and for particular processor models.

Definitions

inv-37: Conductive hearing loss — definition

DefinitionHearing loss due to ineffective conduction through the outer ear canal and the small bones of the middle ear to the inner ear

Clinical implicationMakes it difficult to hear soft sounds and is often correctable medically or surgically

When BAHA consideredImplantable bone-conduction devices are alternatives when air-conduction hearing aids are unsuitable (e.g., atresia, chronic otitis)

inv-38: Mixed hearing loss — definition

DefinitionCombination of conductive and sensorineural components affecting the outer or middle ear and the inner ear (cochlea) or auditory nerve

Clinical implicationReflects both reversible conductive pathology and permanent sensorineural damage; device selection depends on dominant component

Policy Revision History

2025-10-01interim_reviewLatest

Interim review approved Sept 9, 2025; changes effective for dates of service on or after Jan 1, 2026, including added coverage criteria for minors under 18 and Benefit Application update to include WA mandate effective Jan 1, 2026.

2025-08-14minor_update

Minor update adding missing FDA-cleared devices to the manufacturer's list.

2025-05-01

Policy Summary

PayerPremera Bluecross

PolicyImplantable Bone-Conduction and Bone-Anchored Hearing Aids

Policy CodePolicy 7.01.547

Change TypeCriteria additions and coding updates

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization when the plan requires it and document otolaryngologist clearance for minors within the preceding six months.

SourceLink

On This Page

Recommended skin thicknessReduce skin thickness to approximately 4–5 mm over the implant to facilitate transcutaneous magnetic transmission

PurposeThinning of tissue improves acoustic transmission between implanted and external magnets in partially implantable magnetic systems

ContextApplied when surgically placing partially implantable (magnetic) bone-conduction hearing systems

Documentation Required

Required Clinical Documentation

Medical records must document that medical necessity criteria are met. For minors under 18, documentation must include medical clearance within the preceding 6 months from an otolaryngologist (initial evaluation) or a licensed physician confirming no substantial change in clinical status since the otolaryngologist evaluation.

Document otolaryngologist clearance (or licensed physician confirmation) for minors within prior 6 months.
Include type of hearing loss, results of audiologic testing, and any ear conditions preventing air-conduction hearing aid use.
Document device type and applicable CPT/HCPCS codes when submitting claims.

Denial Risk

Denial Risks & Benefit Limits

Coverage is subject to member benefit limits and exclusions. Replacement parts, upgrades, or requests when original criteria are not met or the device is functional may be denied as not medically necessary. Providers should check member contract and benefits before ordering or billing.

Replacement parts/upgrades may be denied if initial medical necessity criteria are not met or device is functional.
Check member benefit booklet for limits, frequency (WA: every 36 months per ear for applicable plans), and cost-sharing rules.

Relevance to policyMixed losses are an indicated condition for implantable or non-implanted bone-conduction devices when criteria are met

inv-39: Sensorineural hearing loss — definition

DefinitionDamage to the hair cells inside the inner ear (cochlea) or to the auditory nerve

Clinical implicationTypically permanent and not correctable medically or surgically; often managed with air-conduction amplification or cochlear implants depending on severity

Policy noteImplantable bone-conduction devices are primarily indicated for conductive or mixed losses; sensorineural loss alone is generally not an indication for BAHA implantation

inv-40: Pure-tone average (PTA) — definition

DefinitionPure-tone average (PTA) is the average of an individual’s hearing level calculated at specified frequencies (commonly 0.5, 1, 2, and 3 kHz) to quantify hearing loss

UsePTA is used to determine eligibility thresholds for devices and to classify degree of hearing loss

Frequency set in policyPolicy uses PTA at 0.5, 1, 2, and 3 kHz (same as 500, 1000, 2000, 3000 Hz)

inv-41: Hearing loss degree — degree classification by PTA

Classification by PTAMild: 20–40 dB; Moderate: 40–60 dB; Severe: 60–80 dB; Profound: ≥80 dB

Normal hearing0–20 dB PTA

Clinical relevanceDegree classification guides device candidacy and expected benefit from amplification

inv-42: BAHA / implantable bone-conduction system — definition and brief description

DefinitionBAHA (bone-anchored hearing aid) is an implantable bone-conduction system anchored in the temporal bone that transmits vibrations via osseointegration to the cochlea

MechanismsCan transmit via a percutaneous abutment or transcutaneously using magnetic coupling in partially implantable systems

IndicationsPrimarily indicated for conductive or mixed hearing loss and can be used with CROS for single-sided deafness when appropriate

inv-43: ADHEAR — non-invasive bone conduction device referenced in policy updates

DefinitionADHEAR is a non-invasive bone-conduction hearing system cleared by the FDA (K172460) that uses an elastic headband or adhesive adapter to position the processor on the head

Intended useIntended to treat conductive hearing loss or single-sided deafness via adhesive or headband coupling without surgical implantation

Policy changeMedical necessity criteria for ADHEAR were added to the policy during renumbering/updates

inv-44: BAHA Softband — transcutaneous BAHA option with Softband; criteria reinstated

DescriptionBAHA Softband is a transcutaneous option that attaches the sound processor to the head with a soft or hard band, requiring no implantation

Pediatric useCleared for marketing for use in children younger than 5 years (FDA K002913) and may be used as a non-implant trial

Policy statusCriteria for transcutaneous BAHA with Softband were reinstated in the policy during renumbering (7.01.547)

Annual review approved April 21, 2025; coding update removed HCPCS L8625 and added CPT code 69719 effective Aug 1, 2025 following 90-day provider notification.

2023-02-01renumbering_and_criteria_addition

Policy renumbered to 7.01.547 (approved Jan 10, 2023); criteria reinstated for transcutaneous BAHA with Softband and medical necessity criteria added for the ADHEAR device and for replacement parts/upgrades.

2021-05-01annual_review

Annual review approved April 1, 2021; literature review through Jan 10, 2021 updated the policy with references; policy statements unchanged.

2012-10-09new_policy

Original policy established Oct 9, 2012, including medical necessity criteria for BAHA use with headband or softband in children under 5 and a replacement-parts frequency table in the Benefit Application.