B1300
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Pre-operative assessment of air-bone gap: documented air-bone gap measurements to predict potential BAHA benefit and to support selection (noted as useful in predicting whether speech recognition may improve or deteriorate with BAHA vs air-conduction aids).
- Trials of non-implantable options where appropriate: documentation of trials with alternatives (e.g., CROS hearing aids, Softband/Headband BAHA/processor on Softband) when clinically indicated and as part of comparative assessment (some studies trialed CROS prior to BAHA).
- Device-specific criteria documentation: for bilateral fittings document symmetry of BC thresholds (interaural difference <10 dB average or <15 dB at individual frequencies); for SSD document normal hearing in the better ear (AC PTA ≤ 20 dB HL).
Key Coverage Criteria
- Bilateral symmetric moderate-to-severe conductive or mixed hearing loss (bilateral implant is intended for bilaterally symmetric losses).
- Patients who have an almost instantaneous skin reaction to ear molds (i.e., cannot tolerate conventional earmolds/air-conduction aids).
- Otosclerosis as a third treatment option for patients who cannot or will not undergo stapedectomy.
- Children: bilateral BAHAs in children with bilateral conductive hearing loss and unilateral BAHA or unilateral hearing aid in children with unilateral conductive hearing loss (studies report audiologic benefits and high patient/parent satisfaction).
- Patients with mixed hearing loss and a significant air-bone gap: BAHA may provide better speech recognition than BTE devices when the average air-bone gap exceeds approximately 30–35 dB (some data suggest >35 dB; earlier reports cited 25–30 dB).
- Bonebridge System (MED-EL) — FDA/cleared indications: individuals 12 years of age or older with conductive or mixed hearing loss who can still benefit from amplification (PTA bone conduction threshold at 0.5, 1, 2, 3 kHz ≤ 45 dB HL); bilateral fitting intended for symmetric conductive/mixed loss (interaural BC difference <10 dB average or <15 dB at individual frequencies); individuals with SSD where the hearing ear AC PTA (0.5,1,2,3 kHz) ≤ 20 dB HL.
1 Active Policy
AETNA-CPB-0403 — Bone-Anchored Hearing Aids
Related Codes
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