Does 69718 require prior authorization?

No, 69718 does not require prior authorization (high confidence). Code is covered without prior authorization.

`69718`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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).

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

AMBETTER-CP.MP.93 — Bone-Anchored Hearing Aid

ANTHEM-CG-SURG-82 — CG-SURG-82 Bone-Anchored and Bone Conduction Hearing Aids

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