H65.20 — Chronic serous otitis media, unspecified ear
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This document (background/review section) does not specify documentation requirements, prior authorization criteria, frequency limits, ICD-10 or CPT codes, or other medical-record requirements for phonophoresis.
- No explicit 'Documentation Requirements' section is present in this text chunk.
- None specified in the policy.
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
3 Active Policies
AETNA-CPB-0210 — Phonophoresis
ANTHEM-CG-SURG-82 — CG-SURG-82 Bone-Anchored and Bone Conduction Hearing Aids
ANTHEM-CG-SURG-117 — CG-SURG-117 Balloon Dilation of the Eustachian Tubes
Related Codes
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