Clinical Policy: Bone-Anchored Hearing Aid Form

CENTENE
Corporation

Clinical Policy: Bone-Anchored Hearing Aid
Reference Number: CP.MP.93
Date of Last Revision: 06/25

Coding Implications
Revision Log

See Important Reminder at the end of this policy for important regulatory and legal information.

Description
Bone-anchored hearing aids (BAHAs) are an alternative to conventional hearing aids when physical or medical complications prevent adequate functional improvement in hearing. Sound quality of BAHAs is superior to traditional air-conduction hearing aids, and pain/discomfort is largely diminished with BAHAs.¹

Policy/Criteria

II. It is the policy of health plans affiliated with Centene Corporation that replacement of bone-anchored hearing aids (BAHAs) and/or external components (external sound processor) is considered medically necessary when meeting any of the following:
A. The existing device(s) is no longer functional and cannot be repaired;
B. A change in condition makes the existing unit(s) inadequate for the hearing-related activities of daily living, and improvement is expected with replacement unit(s);
C. The current sound processor is at least five years old.

III.It is the policy of Health Plans affiliated with Centene Corporation that replacement or upgrade of an existing, properly functioning bone-anchored hearing aid (BAHA) and/or its external components (external sound processor) is considered not medically necessary when requested only for convenience or to simply upgrade to a newer technology before the timeframe noted in section II.

Background
There are an estimated 48 million adults and 1.7 million school-aged children in the United States with some type of hearing loss. Hearing loss can be classified as sensorineural (inner ear), conductive (external and middle ear), or mixed, and may be present in one or both ears.⁹

Physical and medical complications such as chronic ear infections and canal deformities can make it difficult to impossible for some to wear hearing aids. Poorly fitting ear molds can lead to bothersome feedback and inadequate functional gain. Implantable hearing devices can improve reliability and functional gain over the standard air-conduction hearing aids when some of these issues exist.

Compared to bone conduction hearing aids held against the skull with a headband, implantable bone conduction hearing aids have advantages such as better tolerability and improved sound quality.⁷ The bone-anchored hearing aid (BAHA) is the most widely used implantable bone-anchored prosthetic hearing aid device.⁷ BAHAs are indicated for people with conductive hearing loss, mixed hearing loss, or single sided profound sensorineural hearing loss to achieve improved auditory acuity by transmitting the sound directly through the bone into the inner ear. The appropriate device is selected based upon the patient’s hearing level.

A BAHA consists of a titanium implant surgically inserted into the skull attached to an abutment of which a small portion protrudes through the skin and forms a snap attachment point for a removable bone conduction hearing aid or processor.⁷ The BAHA is implanted unilaterally or bilaterally, and children are usually around six years old before an implantable BAHA is feasible due to the need for three to four mm of bone to ensure osseointegration.⁶ The processor is adjusted to the patient’s level of hearing, much like in a traditional hearing aid fitting. When complications occur, the majority of them are related to skin issues around the implant. Proper skin care and hygiene at the surgical and abutment sites are essential to maintain good skin integrity.

Coding Implications
This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2024, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage.

Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services.

3. Hagr A. BAHA: Bone-Anchored Hearing Aid. Int J Health Sci (Qassim). 2007;1(2):265-276.
4. Hol MK, Cremers CW, Coppers-Schellekens W, Snik AF. The BAHA Softband. A new treatment for young children with bilateral congenital auricular atresia. Int J Pediatr Otorhinolaryngol. 2005;69(7):973-980. doi:10.1016/j.ijporl.2005.02.010
5. Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1852. doi:10.1001/archinternmed.2011.506
6. Smith RJH, Gooi A. Hearing loss in children: Treatment. UpToDate. www.uptodate.com. Published July 19, 2022. Accessed April 17, 2025.
7. Weber PC. Hearing amplification in adults. UpToDate. www.uptodate.com. Published April 17, 2024. Accessed April 17, 2025.
8. Roman S, Nicollas R, Triglia JM. Practice guidelines for bone-anchored hearing aids in children. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):253-258. doi:10.1016/j.anorl.2011.04.005
9. Health Technology Assessment. Transcutaneous Bone-Anchored Hearing Aids. Hayes. www.hayesinc.com. Published December 29, 2022. Accessed April 17, 2025.

Important Reminder
This clinical policy has been developed by appropriately experienced and licensed health care professionals based on a review and consideration of currently available generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by this clinical policy; and other available clinical information. The Health Plan makes no representations and accepts no liability with respect to the content of any external information used or relied upon in developing this clinical policy. This clinical policy is consistent with standards of medical practice current at the time that this clinical policy was approved. “Health Plan” means a health plan that has adopted this clinical policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any of such health plan’s affiliates, as applicable.

The purpose of this clinical policy is to provide a guide to medical necessity, which is a component of the guidelines used to assist in making coverage decisions and administering benefits. It does not constitute a contract or guarantee regarding payment or results. Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions, and limitations of the coverage documents (e.g., evidence of coverage, certificate of coverage, policy, contract of insurance, etc.), as well as to state and federal requirements and applicable Health Plan level administrative policies and procedures.

This clinical policy is effective as of the date determined by the Health Plan. The date of posting may not be the effective date of this clinical policy. This clinical policy may be subject to applicable legal and regulatory requirements relating to provider notification. If there is a discrepancy between the effective date of this clinical policy and any applicable legal or regulatory requirement, the requirements of law and regulation shall govern. The Health Plan retains the right to change, amend or withdraw this clinical policy, and additional clinical policies may be developed and adopted as needed, at any time.

This clinical policy does not constitute medical advice, medical treatment or medical care. It is not intended to dictate to providers how to practice medicine. Providers are expected to exercise professional medical judgment in providing the most appropriate care and are solely responsible for the medical advice and treatment of member/enrollees. This clinical policy is not intended to recommend treatment for member/enrollees. Member/enrollees should consult with their treating physician in connection with diagnosis and treatment decisions.

Providers referred to in this clinical policy are independent contractors who exercise independent judgment and over whom the Health Plan has no control or right of control. Providers are not agents or employees of the Health Plan.

This clinical policy is the property of the Health Plan. Unauthorized copying, use, and distribution of this clinical policy or any information contained herein are strictly prohibited. Providers, member/enrollees and their representatives are bound to the terms and conditions expressed herein through the terms of their contracts. Where no such contract exists, providers, member/enrollees and their representatives agree to be bound by such terms and conditions by providing services to member/enrollees and/or submitting claims for payment for such services.

Note: For Medicaid member/enrollees, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence. Please refer to the state Medicaid manual for any coverage provisions pertaining to this clinical policy.

Note: For Medicare member/enrollees, to ensure consistency with the Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD), all applicable NCDs, LCDs, and Medicare Coverage Articles should be reviewed prior to applying the criteria set forth in this clinical policy. Refer to the CMS website at http://www.cms.gov for additional information.

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