Anthem Blue Cross Connecticut CG-SURG-82 Bone-Anchored and Bone Conduction Hearing Aids Form

This document addresses the use of bone-anchored and bone conduction hearing aids. These devices are proposed as an alternative to a conventional air conduction hearing aid in the treatment of moderate-to-severe hearing loss or to improve speech recognition in individuals with unilateral sensorineural hearing loss (also referred to as single-sided deafness). This document does not address audiology services, such as those relating to fitting and programming the bone-anchored (BAHA) device.

Note: Please see the following documents related to implants and hearing aids for the treatment of hearing loss:

• CG-DME-37 Air Conduction Hearing Aids
• CG-SURG-81 Cochlear Implants and Auditory Brainstem Implants
• SURG.00084 Implantable Middle Ear Hearing Aids

Note: Benefit language supersedes this document. Hearing aids are not a covered benefit under all member contracts/certificates. Please see the text in the footnote of this document regarding Federal and State mandates and contract language, as these requirements or documents may specifically address the topic of hearing aids.

Clinical Indications

Medically Necessary:

I.    Bilateral Hearing Loss

The following devices are considered medically necessary for the age groups specified (criterion A) when the audiologic (criterion B) and medical condition (criterion C) criteria listed below have been met:

1. Devices:
   1. 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
   2. A transcutaneously worn bone conduction hearing aid that is applied to the head with a headband or adhesive adapter, regardless of age;
      and
2. Audiologic criteria:
   1. For bilateral implants:
      Conductive or mixed (conductive and sensorineural) hearing loss with symmetric bone conduction threshold appropriate to the device used*; or
   2. For a unilateral implant:
      Conductive or mixed (conductive and sensorineural) hearing loss with pure tone average bone conduction threshold appropriate to the device used*;
      and
3. Medical condition criteria (must meet at least one):
   1. Congenital or surgically induced ear malformations of the external or middle ear canal (for example, atresia); or
   2. Severe chronic external otitis or otitis media; or
   3. Tumors of the external ear canal or tympanic cavity; or
   4. Dermatitis of the external ear canal, including reactions from ear molds used in air conduction hearing aids; or
   5. 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)

A fully- or partially-implantable bone conduction (bone-anchored) hearing aid is considered medically necessary for individuals 5 years of age and older with unilateral conductive, mixed or sensorineural hearing loss and normal hearing** in the other ear.

A transcutaneously worn hearing aid utilizing a headband or adhesive adapter is considered medically necessary for individuals of any age with unilateral conductive, mixed or sensorineural hearing loss and normal hearing** in the other ear.

**Normal hearing in the non-affected ear is defined as pure tone average air conduction threshold less than or equal to 20 decibels at 0.5, 1, 2, and 3 kilohertz.

III. Replacement Parts and Upgrades

Replacement parts or upgrades to existing bone conduction (bone-anchored) hearing aid components (for example, batteries, processor, headband or adhesive adapter) are considered medically necessary for individuals whose response to existing components is inadequate to the point of interfering with activities of daily living or when components are no longer functional and can’t be repaired with return to normal function. 

Not Medically Necessary:

The following are considered not medically necessary when the medically necessary criteria above have not been met:

1. Fully-implantable bone conduction (bone-anchored) hearing aids;
2. Partially-implantable bone conduction (bone-anchored) hearing aids;
3. Transcutaneously worn hearing aids applied to the head with a headband or adhesive adapter.

Replacement parts or upgrades to existing fully- or partially-implanted bone conduction (bone-anchored) or transcutaneously worn hearing aid components (for example, batteries, processor, headband, or adhesive adapter systems) are considered not medically necessary when:

1. The medically necessary criteria for replacement parts or upgrades specified above have not been met; or
2. When requested for convenience; or
3. To upgrade to newer technology when the current components remain functional.

An intraoral bone conduction hearing aid is considered not medically necessary for all indications.