69716
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
8.80
Facility
$544.43
Non-Facility
$544.43
Documentation Required
- Audiometric test results showing pure tone average bone conduction thresholds at 0.5, 1, 2, and 3 kHz.
- Unaided speech discrimination score documented in the record.
- Clinical documentation that hearing could not be restored with a conventional air-conductive hearing aid or justification for using an implant or headband device.
- Clinical documentation of the physical or medical complication preventing hearing aid use (for example, chronic ear infections or canal deformities).
Key Coverage Criteria
- Other anatomic or medical conditions that contraindicate the use of an air conduction hearing aid.
- *Please refer to the Discussion section of this document for a list of device-specific thresholds.
- II. Unilateral Hearing Loss (Conductive, Mixed or Sensorineural)
- The following devices are consideredmedically necessaryfor the age groups specified(criterion A) when the audiologic (criterion B) and medical condition (criterion C) criteria listed belowhave been met:
- Devices:Fully- or partially-implantable bone conduction (bone-anchored) hearing aid, including as an alternative to an air conduction hearing aid for individuals 5 years of age or older;orA transcutaneously worn bone conduction hearing aid that is applied to the head with a headband or adhesive adapter,regardless of age;and
- Fully- or partially-implantable bone conduction (bone-anchored) hearing aid, including as an alternative to an air conduction hearing aid for individuals 5 years of age or older;or
2 Active Policies
AMBETTER-CP.MP.93 — Bone-Anchored Hearing Aid
ANTHEM-CG-SURG-82 — CG-SURG-82 Bone-Anchored and Bone Conduction Hearing Aids
Related Codes
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