ModifiedPremera BluecrossPolicy 7.01.547

Implantable Bone-Conduction and Bone-Anchored Hearing Aids

Defines medical necessity, coverage, documentation, coding, and age/benefit application for implantable and non-implantable bone-conduction (bone-anchored) hearing aids for Premera members, including Washington-specific mandate details.

Policy Summary

PayerPremera Bluecross

PolicyImplantable Bone-Conduction and Bone-Anchored Hearing Aids

Policy CodePolicy 7.01.547

Change TypeRevised — effective date and Washington mandate updates

Effective DateJan. 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document medical clearance and audiologic results when requesting coverage for implantable or non‑implantable bone-conduction hearing devices.

SourceLink

POLICY UPDATE CHANGES

Policy revised; effective date listed as Jan. 1, 2026 and references Washington mandate changes.

aged 5+minimum age for surgical implantation

under 5non-implanted option for young children

PTA ≤20 dBcontralateral ear threshold in SSD criteria

5 yrsreplacement processor RUL

69719

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CPT added (provider notif.)

Jan 1, 2026WA mandate effective

Coverage Criteria for Bone-Conduction & Bone-Anchored Hearing Aids

Unilateral conductive or mixed hearing loss

Covered when ONE of the listed medical criteria is present AND audiologic criterion is met

Medical criteria (ONE of): Congenital or surgically induced malformations (atresia) of the external ear canal or middle ear; chronic external otitis or otitis media; tumors of the external canal and/or tympanic cavity; dermatitis of the external canal.

Audiologic criterion: Pure tone average bone-conduction threshold at 0.5, 1, 2 and 3 kHz within device-specific limits (e.g., ≤45 dB for OBC and BP100 devices; ≤55 dB for Intenso device; ≤65 dB for Cordelle II device).device-specific

See device Table/Definitions for exact device thresholds and measurement at 4 kHz for some devices.

Bilateral conductive or mixed hearing loss

Covered when ALL of the unilateral criteria are met plus bilateral/symmetry criteria

Base criteria: All unilateral medical and audiologic criteria are met for both ears.

Symmetry: Symmetric conductive or mixed hearing loss defined as between-ear bone-conduction difference <10 dB on average measured at 0.5, 1, 2 and 3 kHz (4 kHz for some devices) OR <15 dB at individual frequencies.<10 dB average or <15 dB individual

Device-specific bilateral thresholds apply (see Table/Definitions).

Single-sided sensorineural deafness (SSD)

Covered when ALL of the following are met

Age: Individual is aged 5 years or older.>=5 years

FDA-cleared implantation indications generally apply to age ≥5 years.

Hearing status: Single-sided sensorineural deafness (SSD) in one ear with normal hearing in the contralateral ear, defined as pure tone average air-conduction threshold ≤20 dB at 0.5, 1, 2 and 3 kHz.PTA <=20 dB

Implantable bone-conduction device considered an alternative to an air-conduction contralateral routing of signal (CROS) hearing aid.

Non-implanted (transcutaneous) use / children <5

Covered when ALL of the following are met

Age: Child under 5 years of age.<5 years

Surgical implantation is not routinely performed or FDA-cleared for children under 5; non-implanted transcutaneous options are used as interim/trial devices.

Hearing criteria: Conductive or mixed hearing loss meeting device-specific pure tone average bone-conduction thresholds OR single-sided sensorineural deafness with normal contralateral ear PTA ≤20 dB.device-specific PTA or PTA<=20 dB

Non-implanted sound processors held on the skull with softband/headband or ADHEAR adhesive adapter are considered medically necessary alternatives for children <5 and may be used as pre-surgical trials.

Medical necessity and evidence

Coverage stance and evidence summaries

Conductive or mixed hearing loss: For individuals with conductive or mixed hearing loss, implantable bone-anchored hearing aids (percutaneous or partially implantable transcutaneous systems) are supported by observational studies that report within-subject improvements in hearing; the evidence is sufficient to conclude a net health benefit in eligible individuals.

Evidence base: observational pre-post studies; no prospective randomized trials but consistent objective improvements attributable to device.

Single-sided deafness (SSD)/Unilateral SNHL: For unilateral sensorineural hearing loss treated with BAHA using contralateral routing of signal, evidence is mixed: single-arm case series report subjective improvements, but systematic review and limited RCT data do not demonstrate clear objective benefits in speech recognition or localization; evidence is insufficient to confirm net health benefit.

Quality RCTs are lacking; systematic review found no improvement in key objective measures.

Indications per FDA: FDA-cleared indications include individuals with conductive or mixed hearing loss who can benefit from amplification; bilaterally symmetric conductive/mixed loss (may be implanted bilaterally); single-sided sensorineural deafness; and candidates for AC CROS who cannot wear AC CROS devices.

Other uses of implanted bone-conduction (bone-anchored) hearing aids that are not specified in the coverage criteria are considered investigational. This includes use in individuals with bilateral sensorineural hearing loss and any application for which the policy does not list medical necessity criteria. Requests for such indications lack sufficient evidence of clinical benefit and should be evaluated as investigational.

These devices and the implantation surgery are reimbursed under the medical benefit because they are surgically implantable prosthetic devices that replace middle ear function and do not meet the payer definition of excluded hearing aids. Non‑surgical transcutaneous applications (for example, BAHA processor on a headband/softband or ADHEAR adhesive adapter) for children under age 5 are also reimbursed under the medical benefit per the Benefit Application. Health carriers may require prior authorization or other utilization controls when approving coverage for medically necessary bone-conduction hearing instruments; providers should follow the carrier's prior authorization processes and member benefit requirements.

The policy history notes prior renumbering and replacement events. On 10/09/12 this policy replaced 7.01.03; in 05/01/20 the policy was deleted and replaced with 7.01.03 (effectively a renumbering and removal of some transcutaneous BAHA criteria and HCPCS L8692), and subsequent updates reinstated criteria for transcutaneous BAHA with Softband and added ADHEAR criteria. The history documents iterative literature reviews and coding updates through the current revision.

Replacement parts and upgrades (batteries, processors, headbands, adhesive adapters, abutments, etc.) are considered not medically necessary when the requested items are for the convenience of the individual, when the current components remain functional, or when the parts/upgrades are requested but the original medical necessity criteria for the device have not been met. Conversely, parts or upgrades are considered medically necessary when the component is nonfunctional, cannot be repaired, or the individual's response to the device is inadequate and replacement is required.

Evidence for use of BAHA in unilateral sensorineural hearing loss (single-sided deafness) is inconclusive. Case series report subjective improvements in speech quality and satisfaction, but systematic review and limited randomized data do not demonstrate consistent objective improvements in speech recognition or sound localization. Overall, the evidence is insufficient to establish a clear net health benefit for BAHA in unilateral sensorineural hearing loss.

The current excerpt does not present extensive standalone 'Not Medically Necessary' statements beyond those for replacement parts/upgrades and investigational indications. The policy history records changes in investigational and coverage language over time (including deletions, reinstatements, and coding updates), which explains prior variations in explicit wording of not‑medically‑necessary determinations.

Coding and Product Codes

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	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 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 product codesmixed

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

Referenced HCPCS/CPT changes in historymixed

L8694	HCPCS code L8694 (added May 2018; specific description not in excerpt)
L8695	HCPCS code L8695 (added then removed in history; removed May 2019 as noted)
L8625	HCPCS code L8625 (added May 2019; later removed May 01, 2025)
69716	CPT code added Jan 01, 2022 (description not specified in excerpt)
69719	CPT code added effective Aug 01, 2025 (provider notification)

FDA product codesneutral

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

Pure tone average bone-conduction thresholds by device

OBC and Ponto Pro / OBC & Ponto 5 seriesUnilateral PTA bone-conduction threshold ≤45 dB (device unilateral limit <45 dB); bilateral use defined by between-ear difference ≤10 dB average or ≤15 dB individual.

BAHA Intenso / Cochlear Osia2 / similar high-power devicesUnilateral PTA bone-conduction threshold ≤55 dB (device unilateral limit <55 dB).

BAHA Cordelle II and Ponto SuperPower variantsUnilateral PTA bone-conduction threshold up to ≤65 dB for specified devices (e.g., Cordelle II, Ponto 5 SuperPower).

Recommended skin thickness over implant

Recommended skin thickness

Provider Requirements, Prior Authorization & Documentation

Prior Authorization

Prior Authorization Required

Prior authorization may be required by the health carrier for medically necessary bone‑conductive hearing devices, including implantable and non‑implantable (softband/headband/ADHEAR) processors. Lack of required prior authorization or other utilization controls may result in denial or retroactive denial of coverage.

Applies to implantable and non‑implantable bone‑conduction devices
Check member contract for prior authorization process and submission requirements

Prior Authorization

Prior Authorization and Coverage Frequency

Health carriers may require prior authorization and may limit coverage frequency. For plans subject to the Washington mandate (issued/renewed on or after Jan 1, 2026), hearing instruments are covered every 36 months per ear. Carriers may still require prior authorization or other utilization controls when approving coverage.

Frequency limit: every 36 months per ear for applicable Washington fully‑insured plans (plans issued/renewed on or after Jan 1, 2026)
Verify whether deductible applies (statute: services not subject to enrollee deductible unless plan is HSA‑qualified)

Background and Clinical Context

Bone‑anchored hearing aids convert airborne sound into skull vibrations that bypass the outer and middle ear and stimulate the cochlea, producing perception of sound. They are surgically implantable prosthetic devices (with percutaneous or magnetic/transcutaneous coupling options) and are used as alternatives to air‑conduction hearing aids or CROS systems for conductive or mixed hearing loss, congenital ear canal malformations, chronic external otitis or otitis media, dermatitis of the external canal, and single‑sided deafness in selected candidates.

Definitions

Conductive hearing loss

DefinitionConductive hearing loss: sound is not conducted effectively through the outer ear canal and the small bones of the middle ear to the inner ear; often correctable medically or surgically.

Common causesAtresia of the external ear canal, chronic otitis media/externa, ossicular chain abnormalities, tumors, or dermatitis of the external canal.

Clinical implicationAir-conduction hearing aids may be ineffective when ear canal or middle ear pathology prevents use; bone-conduction devices bypass outer/middle ear to stimulate cochlea.

Single-sided deafness / CROS

DefinitionSingle-sided deafness (SSD): profound sensorineural hearing loss in one ear with normal or near-normal hearing in the contralateral ear; CROS systems transmit sound from the deaf ear to the better ear.

Policy Revision History

2012-10-09created

New policy created replacing 7.01.03; included medical necessity criteria for BAHA use with headband/softband in children <5 and added BAHA replacement parts frequency table.

2015-03-10annual_review

Annual review with literature update through January 2015; rationale reorganized and references added; policy statements unchanged.

2016-06-01annual_review

Annual review with literature update (changes approved Oct 2016); policy statements unchanged.

Policy Summary

PayerPremera Bluecross

PolicyImplantable Bone-Conduction and Bone-Anchored Hearing Aids

Policy CodePolicy 7.01.547

Change TypeRevised — effective date and Washington mandate updates

Effective DateJan. 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization and document medical clearance and audiologic results when requesting coverage for implantable or non‑implantable bone-conduction hearing devices.

SourceLink

On This Page

See device-specific clearances and device Table/Definitions.

Reduce skin thickness to approximately 4–5 mm over the implant at surgical placement to facilitate magnetic coupling between implant and external processor.

RationaleThinner skin over the implant improves transmission between internal magnet and external magnetically coupled processor.

Surgical noteSurgeon may thin soft tissue to target thickness during implant placement per device requirements.

Denial Risk

Prior Authorization — Verify With Payer

Providers must verify prior authorization requirements and benefit limits with the member's benefit booklet or the carrier's member services before scheduling procedures or dispensing devices. Failure to obtain required prior authorization may lead to denial or retroactive denial.

Check whether the member is in a fully‑insured Washington plan subject to the 36‑month mandate or a self‑funded plan with different terms
Confirm prior authorization submission method, required forms, and timelines

Documentation Required

Required Clinical Documentation

Medical records submitted for review must document that medical necessity criteria are met. For minors under 18, documentation must include medical clearance from an otolaryngologist within the preceding six months for an initial evaluation, or from a licensed physician if there has been no substantial change in clinical status since the otolaryngologist evaluation.

Audiologic test results showing level and type of hearing loss (PTA at 0.5, 1, 2, and 3 kHz; 4 kHz for some devices as specified)
Type of hearing loss and laterality (bilateral, unilateral/SNSD)
Inner or outer ear conditions preventing use of conventional air‑conduction hearing aid
For initial pediatric evaluations, otolaryngology clearance within 6 months; for follow‑up, licensed physician documentation if no substantial change

Note

Non‑Implant Trial for Young Children

For children younger than age 5, non‑implant trials are appropriate and considered medically necessary as interim or trial options prior to implantation eligibility. Use of a bone‑conduction sound processor on a softband or headband, or the ADHEAR non‑invasive device, may be used as a pre‑surgical trial and is covered under the medical benefit when clinical criteria are met.

ADHEAR and softband/headband applications are medically necessary alternatives for children <5 years
Document audiologic thresholds and clinical rationale for trial use prior to implantation

Documentation Required

Documentation / Verification

This policy is a guide. Coverage is subject to the member's benefit plan limits and conditions. Always consult the member benefit booklet or contact customer service to confirm coverage, prior authorization requirements, frequency limits, and whether the plan is subject to state mandates.

State mandate provisions apply to fully‑insured Washington plans issued/renewed on or after Jan 1, 2026; self‑funded groups may differ
Failure to document medical necessity (audiologic test results, hearing loss type, otologic conditions) may result in claim denial

Role of implantable bone-conduction devices

Implantable bone-conduction devices can be considered an alternative to air-conduction CROS systems for individuals with SSD, especially when CROS is unsuitable.

Audiologic requirementNormal hearing in the contralateral ear defined as pure tone average air-conduction threshold ≤20 dB at 0.5, 1, 2 and 3 kHz for SSD candidates aged ≥5 years.

Surgically implantable prosthetic device (bone-conduction hearing aid)

DefinitionSurgically implantable prosthetic device that produces the perception of sound by replacing function of the middle ear, cochlea, or auditory nerve (bone-conduction/osseointegrated implant).

Benefit applicationThese devices treat a medical condition and are reimbursed under the medical benefit rather than as excluded hearing aids.

Transcutaneous applicationTranscutaneous application of BAHA processors (headband/softband or ADHEAR adhesive adapter) for children under 5 is also included under medical benefit guidance.

Non‑surgical transcutaneous attachment

Non-surgical attachment typesSoftband or headband application of a BAHA sound processor or ADHEAR adhesive adapter that holds the processor against the skull without implantation.

Indication in young childrenUsed as a medically necessary interim/trial option in children under 5 years when conductive/mixed loss criteria or SSD criteria are met and implantation is not appropriate.

Trial purposeNon-implant use may be used as a pre-surgical trial to assess benefit prior to implantation in older children.

SoundBite

Product descriptionSoundBite Hearing System: an intraoral bone-conducting hearing prosthesis consisting of a behind-the-ear microphone and an in-the-mouth transducer that transmits sound via the teeth/mandible to the cochlea.

Regulatory noteCleared by FDA in 2011 through the 510(k) process for indications similar to Baha devices; manufacturer Sonitus Medical closed in 2015.

Clinical roleProvided an alternative bone-conduction approach to BAHAs while marketed; no longer commercially available after manufacturer closure.

2017-05-01annual_review

Annual review with literature update; removed investigational statement for partially implantable devices and added partially implantable devices to medically necessary statement; RUL table moved to Policy Guidelines.

2018-05-01annual_review

Annual review with literature update through December 2017; added HCPCS code L8694; policy statements unchanged.

2019-05-01annual_review

Annual review with literature update; removed HCPCS code L8695 and added HCPCS code L8625.

2020-05-01deleted_and_replaced

Policy deleted and replaced with 7.01.03 effective 01/2020; removed criteria for transcutaneous BAHA with Softband and HCPCS L8692 during renumbering.

2021-05-01annual_review

Annual review with literature update through January 10, 2021; policy statements unchanged.

2022-01-01coding_update

Coding update added CPT codes 69716 and 69719.

2022-05-01annual_review

Annual review (approved April 11, 2022) with literature update; policy updated.

2023-02-01renumber_and_update

Policy renumbered from 7.01.03 to 7.01.547; reinstated criteria for transcutaneous BAHA with Softband, added ADHEAR device criteria, and added criteria for replacement parts and upgrades.

2023-05-01annual_review

Annual review with literature update through December 9, 2022; minor editorial refinements; intent unchanged.

2024-05-01annual_review

Annual review with literature update through December 22, 2023; policy statements unchanged.

2025-05-01annual_review

Annual review with literature update through December 16, 2023; removed HCPCS code L8625 and added CPT code 69719 effective August 1, 2025 following 90-day provider notification.

2025-08-14technical_update

Recommended hearing loss thresholds table added.

2025-10-01interim_reviewLatest

Interim review approved September 9, 2025, effective January 1, 2026 following 90-day provider notification; added coverage criteria for minors under 18 and updated Benefit Application to include new Washington mandate language.