01Billing team: Before billing CPT 69714, 69716, 69717, 69719, 69726, 69727, 69728, 69729, 69730 or HCPCS L8690 through L8694 for a bone-anchored hearing aid, confirm the member's contract benefits and exclusions.
02If the member's contract excludes hearing aids, this policy is not applicable unless the contract specifically distinguishes between bone and air conduction hearing aids.
03Document a qualifying criterion, which is a congenital or surgically induced malformation of the external ear canal or middle ear, chronic external otitis or otitis media, a tumor of the external canal or tympanic cavity, or dermatitis of the external canal.
04Document a pure-tone average bone-conduction threshold at 0.5, 1, 2 and 3 kHz of better than or equal to 45 dB for OBC and BP100 devices, 55 dB for Intenso, or 65 dB for Cordele II.
05For bilateral implantation, document symmetrically conductive or mixed hearing loss, with a left and right bone-conduction threshold difference of less than 10 dB on average at 0.5, 1, 2 and 3 kHz, or less than 15 dB at individual frequencies.
06For single-sided sensorineural deafness, document a normal-ear pure tone average air-conduction threshold better than 20 dB at 0.5, 1, 2 and 3 kHz.
07The policy guidelines say skull bone quality and thickness should be assessed for implant stability, and individuals or caregivers must be able to perform proper hygiene to prevent infection.
08BCBSMS makes no payment for services not documented to be medically necessary.
09Uses in individuals with bilateral sensorineural hearing loss are investigational, so review the member's specific benefit plan language before billing those uses.
10For Federal Employee Program members, the policy states that FDA-approved devices may not be considered investigational and may be assessed only on the basis of their medical necessity.