69726
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.20
Facility
$422.52
Non-Facility
$422.52
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
- Members with physical or medical complications that prevent adequate functional improvement from conventional (air-conduction) hearing aids
- Implantable device for patients aged ≥5 years; headband device for patients <5 years or for patients medically unable to receive an implant.
- Unilateral or bilateral conductive and/or mixed hearing loss, or unilateral sensorineural hearing loss (deafness in one ear with normal hearing in the other), when hearing cannot be restored with a conventional air-conductive hearing aid.
- Pure tone average bone conduction threshold (measured at 0.5, 1, 2, and 3 kHz) consistent with the FDA indications for the requested device.
- Unaided speech discrimination score ≥ 60%.
- For bilateral BAHA, a mean maximum difference < 10 dB between right and left bone conduction thresholds.
1 Active Policy
AMBETTER-CP.MP.93 — Bone-Anchored Hearing Aid
Related Codes
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