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External Hearing Aids, Auditory Brainstem Implant, Bone-Anchored Hearing Devices and Audiological Testing

Section: Surgery
Effective Date: July 01, 2018
Revised Date: November 14, 2019
Last Reviewed: November 14, 2019

Description

Hearing impairment is a reduction in the ability to perceive sound. Hearing impairments can vary from slight to profound and are generally classified as conductive hearing loss, sensorineural hearing loss or mixed hearing loss.

Criteria

Hearing Aids

Prescribed U.S. Food and Drug Administration (FDA)-approved hearing aids are eligible for payment (per the FDA, hearing aids marketed for use by the general public should have FDA approval). Any hearing aid that is not FDA approved will be denied as non-covered.

Procedure Codes

V5010 V5030 V5040 V5050 V5060 V5070 V5080
V5100 V5120 V5130 V5140 V5150 V5171 V5172
V5181 V5190 V5211 V5212 V5213 V5214 V5215
V5221 V5230 V5242 V5243 V5244 V5245 V5246
V5247 V5248 V5249 V5250 V5251 V5252 V5253
V5254 V5255 V5256 V5257 V5258 V5259 V5260
V5261 V5262 V5263 V5298 V5299

Assistive Listening Devices

Assistive listening devices are used to improve speech intelligibility by reducing the degrading effects of distance and background noise. These devices are functionally similar to a personal sound amplifier system. These devices do not replace the function of the middle ear, cochlea or auditory nerve. Therefore, they are not considered as prosthetic devices and are non-covered.

Procedure Codes

V5281 V5282 V5283 V5284 V5285 V5286 V5287
V5288 V5289 V5290

Middle Ear Implant

Bone Anchored Hearing Devices (BAHA), may be considered medically necessary as prosthetic devices when the following indications and criteria are met:

The BAHA is indicated for conductive or mixed hearing loss. This includes at least ONE of the following:

  • Congenital or surgically induced malformation (e.g., atresia) of the external ear, ear canal, or middle ear; or
  • Infection of the ear canal resulting in chronic draining ears; or
  • Fixation of the ossicles (middle ear bones); or
  • Single sided deafness due to: (allow stimulation of the functioning cochlea)
    • Viral infections; or
    • Meniere’s Disease; or
    • Trauma; or
    • Measles; or
    • Sudden deafness; or
    • Acoustic Neuroma; or
    • Tumors of the external canal and/or tympanic cavity; or
    • Dermatitis of the external canal; or
    • Severe chronic external otitis or otitis media; and
  • There must be a functioning cochlea or cranial nerve VIII for the BAHA to work; and
  • The following audiologic criteria must be met:
    • A pure tone average (PTA) bone-conduction threshold measured at 0.5, 1, 2, and 3 kHz of better than or equal to 45 dB (OBC and BP100 devices), 55 dB (Intenso device) or 65 dB (Cordele II device).

For bilateral implantation, individuals should meet the above audiologic criteria, and have a symmetrically conductive or mixed hearing loss as defined by a difference between left and right side bone conduction threshold of less than 10 dB on average measured at 0.5, 1, 2 and 3 kHz, or less than 15 dB at individual frequencies.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Quantity level limits or quantity of supplies that exceed the frequency guidelines listed on the policy will be denied as not medically necessary.

BAHA for any other indication than listed above is considered not medically necessary.

Procedure Codes

61520 61530 61598 69714 69715 L8690 L8692
L8693 L8699 S2230 V5095

An implantable bone-conduction (bone-anchored) hearing aid may be considered medically necessary:

  • As an alternative to an air-conduction CROS hearing aid in individuals 5 years of age and older with single-sided sensorineural deafness and normal hearing in the other ear; and
  • The pure tone average air conduction threshold of the normal ear should be better than 20 dB measured at 0.5, 1, 2, and 3 kHz.

Other uses of bone-conduction (bone-anchored) hearing aids, including use in individuals with bilateral sensorineural hearing loss, are considered experimental/investigational and, therefore, non-covered.

Partially implantable magnetic bone-conduction hearing systems using magnetic coupling for acoustic transmission (e.g., Otomag Alpha 1 and BAHA Attract) are considered experimental/investigational and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

69714 69715 69799 L8699

Auditory Brainstem Implant

Unilateral use of an auditory brainstem implant (using surface electrodes on the cochlear nuclei) may be considered medically necessary in individuals with neurofibromatosis type II, 12 years of age or older, who are rendered deaf due to bilateral resection of neurofibromas of the auditory nerve.

An auditory brainstem implant is considered experimental/investigational, and, therefore, non-covered for any other condition than listed above, including nonneurofibromatosis type 2 indications.

Bilateral use of an auditory brainstem implant is considered experimental/investigational, and, therefore, non-covered as there are inadequate data to permit scientific conclusions regarding its efficacy.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Processor replacement may be considered medically necessary one (1) per five (5) years. Processor replacement greater than one (1) per five (5) years will be denied as not medically necessary.

Procedure Codes

L8691 L8694 L8699 S2235

Audiological Testing

Audiological testing performed without a physician evaluation and an order for the testing prior to testing are deemed to be screening in nature, and will be considered not medically necessary.

Audiological testing is eligible as a diagnostic procedure, when not screening in nature.

Procedure Codes

0208T 0209T 0210T 0211T 0212T 92550 92553
92555 92556 92557 92558 92559 92560 92561
92562 92563 92564 92565 92567 92568 92570
92571 92572 92575 92576 92577 92579 92582
92583 92584 92585 92586 92587 92588 92620
92621 92626 92627 92630 92633 92640 V5008

Aural Rehabilitation

An audiologist performs the primary evaluation of the status of an aural rehabilitation program under the direction of physicians or speech-language pathologists within their scope of practice.

The speech-language pathologist is typically responsible for evaluating the client’s receptive and expressive communication skills and providing the services to anchor improvement.

Procedure Codes

92626 92627 92630 92633

Diagnosis Codes

Covered Diagnosis Codes for Procedure Codes 61520, 61530, 61598, 69714, 69715, 69799, L8690, L8691, L8692, L8693, L8694, L8699, S2230 and V5095

C30.1

D22.20

D22.21

D22.22

D23.20

D23.21

D23.22

H60.8X1

H60.8X2

H60.8X3

H60.8X9

H60.60

H60.61

H60.62

H60.63

H60.90

H60.91

H60.92

H60.93

H60.399

H61.90

H61.91

H61.92

H61.93

H61.391

H61.392

H61.393

H61.399

H62.8X1

H62.8X2

H62.8X3

H62.8X9

H65.20

H65.21

H65.22

H65.23

H65.30

H65.31

H65.32

H65.33

H65.411

H65.412

H65.413

H65.419

H65.491

H65.492

H65.499

H66.3X1

H66.3X2

H66.3X3

H66.3X9

H66.10

H66.11

H66.13

H66.40

H66.41

H66.42

H66.43

H66.90

H66.91

H66.92

H66.93

H66.001

H66.002

H66.003

H66.004

H66.005

H66.006

H66.007

H66.009

H66.011

H66.012

H66.013

H66.014

H66.015

H66.016

H66.017

H66.019

H67.1

H67.2

H67.3

H67.9

H90.0

H90.2

H90.6

H90.8

H90.11

H90.12

H90.3

H90.41

H90.42

H90.71

H90.72

Q16.0

Q16.1

Q16.3

Q16.4

 

Covered Diagnosis for Procedure Codes S2235 and 92640

237.72

Q85.02

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