1.0 CPT CODES
69710, 69711, 69714, 69715,
69717, 69718
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 United States (US) 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 (Current Procedural Terminology (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.