1.0 CPT
PROCEDURE CODE RANGE
69710, 69711, 69714,
69715, 69717, 69718
2.0 HCPCS
PROCEDURE CODES
L8690, L8691, L8692, L8693
3.0 Description
3.1 A fully-implantable
Auditory Osseointegrated Implant (AOI) device, such as the Bone
Anchored Hearing Aid (BAHA) system, is
based off the process of osseointegration through which living tissue integrates
with titanium in the implant, allowing amplified and processed sound
to be conducted via the skull bone directly to the cochlea. An AOI
device replaces the function of the middle ear (a part of the human
body).
3.2 Partially-implantable AOIs,
such as those with magnetic coupling, are an
alternative where the sound processor connects to the bone percutaneously
via a skin abutment. With these devices, acoustic transmission occurs
transcutaneously via magnetic coupling of the external sound processor and
the internally implanted device components. The bone conduction
hearing system consists of a sound processor, magnetic connection,
and an implant. The sound processor picks up sound, changes it into
vibrations, and sends it directly to the inner ear, bypassing the ear
canal and middle ear.
3.3 Middle Ear Implants (MEIs)
can be either semi-implantable or fully-implantable. With semi-implantable
MEIs, the external part consists of an audio processor, which includes
a microphone, speech processor, and radio frequency transmitter.
The internal, implanted part consists of a radio frequency receiver,
electronic components, and a mechanical vibrator. With fully-implantable
MEIs, all of the components, including the battery and microphone,
are implanted. Both semi-implantable and fully-implantable MEIs
create an electromagnetic field that vibrates and stimulates the
ossicles, sending signals to the cochlea.
3.4 Non-implantable
Bone Conducting Hearing Devices (BCHDs) contain a sound processor
held against the skull with a softband or headband. Non-implantable
BCHDs send sound vibrations through the skin (transcutaneously)
to the skull bone, bypassing the outer and middle ear. Non-implantable BCHDs
for pediatric patients are a medically necessary bridge prosthetic
device for children who are too young to undergo surgery for an
implantable prosthetic hearing device.
3.6 Auditory Brainstem Implants (ABIs). ABIs consist
of an external processor worn on the ear and an internally implanted
component. The external processor picks up sound, converts it into
an electronic signal, and sends the signal to the internal component
that is implanted in the brainstem. ABIs are used to treat deafness
caused by damage to the cochlear or auditory nerves in the ear.
4.0 POLICY
4.1 Prosthetic
hearing devices are covered as prosthetic devices when medically necessary because
of significant conditions resulting from trauma, congenital anomalies,
or disease and the devices have been approved by the U.S. Food and
Drug Administration (FDA). See
Chapter 8, Section 5.1 for TRICARE policy
of FDA approval of medical devices and “off-label uses.”
4.2 Necessary and appropriate services and supplies,
including hearing exams provided by authorized providers, are covered.
4.3 Authority to provide a prosthetic device includes
coverage of the following:
4.3.1 Any accessory or item of supply
that is used in conjunction with the device for the purpose of achieving
therapeutic benefit and proper functioning;
4.3.2 Services necessary to train the recipient of
the device in the use of the device;
4.3.3 Repair of the device for normal wear and tear
or damage;
4.3.4 Replacement of the device
if the device is lost or irreparably damaged or the cost of repair would
exceed 60% of the cost of replacement.
4.3.5 Effective November 8, 2017, semi-implantable
hearing aids or systems that use magnetic coupling AOIs for acoustic
transmission (CPT code 69710) are covered as prosthetic devices.
4.3.6 Effective November 8, 2017, semi-implantable
or fully implantable middle ear implants or systems that use electromagnetic
field transmission (CPT code 69714) are covered as prosthetic devices.
4.3.7 Effective November 21, 2019,
non-implantable BCHDs in children five years of age or younger or
in children whose bone development will not yet support implantation
are covered as prosthetic devices until bone development is mature
enough to support implantation.