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.