Bone-Anchored Hearing Aids (BAHA)

Revised: July 15, 2024

· Overview

· Eligible Providers

· Eligible Members

· Dispensing Fee for Nonsurgical or Non Osseointegrated

· Authorization

· Billing

Overview

A bone-anchored hearing aid (BAHA) is a type of hearing aid that attaches to the bone behind the ear. The device transmits sound vibrations directly to the inner ear through the skull and bypasses the middle ear. It is primarily suited for people who have conductive hearing losses, unilateral hearing loss, single-sided deafness and people with mixed hearing losses who cannot wear in the ear or behind the ear hearing aids.

Nonsurgical devices are worn on a headband or attached directly to the skin with adhesive. Surgical devices include an internal component and an external speech processor. BAHAs are also referred to as auditory osseointegrated devices.

Minnesota Health Care Programs (MHCP) covers U.S. Food and Drug Administration approved BAHA devices which must be dispensed according to their approval guidelines.

Eligible Providers

· Hospitals

· Physicians

· Audiologists

These additional provider types may bill for specific parts and batteries identified in the table found in the billing section.

· Hearing aid dispensers

· Medical suppliers

Eligible Members

MHCP will consider payment of full or partially implantable BAHAs or non-surgical bone conduction devices for members with a unilateral or bilateral conductive or mixed conductive and sensorineural hearing loss.

For surgically implanted BAHA, individuals must be 5 years of age or older.

For nonsurgical BAHA devices, individuals may be of any age.

Criteria

Documentation must explain why the medical condition prevents hearing being restored with a conventional air-conductive hearing aid. Additionally, the member must have any of the following conditions and audiologic criteria:

Conditions

· Congenital or surgically induced malformations of the external ear canal or middle ear; or

· Dermatitis of the external ear, including hypersensitivity reactions to ear molds used in air-conduction hearing aids; or

· Hearing loss secondary to otosclerosis in persons who cannot undergo stapedectomy; or

· Severe chronic external otitis or otitis media; or

· Tumors of the external ear canal and/or tympanic cavity; or

· Other conditions in which an air-conduction hearing aid is contraindicated.

Audiological Criteria

· Unilateral implant: Conductive or mixed (conductive and sensorineural) hearing loss with pure tone average bone conduction threshold values measured at 0.5, 1, 2, and 3 kHz less than or equal to 45 dB HL

· Bilateral implant: Moderate-to-severe bilateral symmetric conductive or mixed (conductive and sensorineural) hearing loss, meeting above-listed bone conduction thresholds in both ears. Symmetric bone conduction threshold is defined as less than:

a. 10 dB average difference between ears (measured at 0.5, 1, 2 and 4 kHz) or less than 15 dB difference at individual frequencies; or

b. 10 dB average difference between ears (measured at 0.5, 1, 2, and 3 kHz), or less than a 15 dB difference at individual frequencies

· Nonsurgical devices: Conductive or mixed (conductive and sensorineural) hearing loss with pure tone average bone conduction threshold values measured at 0.5, 1, 2, and 3 kHz less than or equal to 45 dB HL

Dispensing Fee for Nonsurgical or Non Osseointegrated

MHCP will reimburse the hearing aid service provider one dispensing fee for fitting and dispensing a bone anchored non osseointegrated or nonsurgical hearing aids for a member. Do not submit a claim until after the hearing aid is dispensed.

The dispensing fee includes the following:

· Adjusting the bone anchored non osseointegrated or nonsurgical hearing aid to the wearer, including the necessary programming on digital aids

· A provision of at least three standard hearing aid batteries of the type necessary to operate the hearing aid

· Informing the member of the trial period

· Instructing and counseling the member on use and care of the bone anchored non osseointegrated or nonsurgical hearing aid

· Supplying a written copy of the manufacturer's warranty

· Returning the bone anchored non osseointegrated or nonsurgical hearing aid to the manufacturer for repair during the warranty period

Providers may submit dispensing fee claims when providing replacement bone anchored non osseointegrated or nonsurgical hearing aids. If a dispensing fee has already been paid, authorization is required. For example, providers may bill (with authorization) an additional dispensing fee when bone anchored non osseointegrated or nonsurgical hearing aids are replaced under the manufacturer’s loss and damage warranty. No additional dispensing fee is payable for replacing an unsatisfactory bone anchored non osseointegrated or nonsurgical hearing aids during the required trial period.

Authorization

Device repairs over $400 require authorization. Replacement of a BAHA and its external components is considered medically necessary when the existing device cannot be repaired or when replacement is required because a change in the member's condition makes the present unit non-functional and improvement is expected with a replacement unit.

Certain BAHA devices require authorization per the list below. To request an authorization, submit the Authorization Form (DHS-4695) (PDF) to the authorization medical review agent.

Required Documentation
Authorization requests must include the following:

· Diagnosis with the appropriate ICD-10 code

· Medical history pertaining to the bone-anchored hearing aid

· Reports

· Audiology: including the final report from any pre-implant hearing training (children)

· Speech: including test results of age-appropriate closed-set work identification tasks and other tests

· Psychology: including a clear statement as to the individual’s cognitive ability to participate in the post-surgical rehabilitation program

Billing

Providers are responsible to coordinate services. Review MHCP Billing Policy for general billing requirements and guidance for submitting claims.

Bill bone-anchored hearing aids using MN–ITS 837P. Refer to the MHCP MN–ITS 837P Professional User Guides for claim instructions. Refer to the MHCP fee schedule for codes related to the fitting and follow-up of surgical/osseointegrated bone anchored devices.

Use the following table for billing codes and provider types that may provide and bill for the services listed.

HCPCS Code	HCPCS Description	Authorization Requirement	Provider Type
L8690	Auditory osseointegrated device, includes all internal and external components	Yes	Hospital, physician, audiologist
L8691	Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each	Yes	Hospital, physician, audiologist, hearing aid dispenser, medical supplier
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, audio body worn, includes headband or other means of external attachment	Yes
L8693	Auditory osseointegrated device abutment, any length, replacement only	No
L8694	Auditory osseointegrated device, transducer/actuator, replacement only	No
L8624	Lithium-ion battery for use with cochlear implement device or auditory osseointegrated device speech processor, ear level, replacement, each	No
L8625	External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each	No

Dispensing Fee Claims

Dispensing fee claims must meet the following requirements:

· Providers are required to bill their usual and customary charge

· Claims may not be submitted before the hearing aid(s) is dispensed

· Use the appropriate HCPCS code

· Bill the dispensing fee procedure code for the type of hearing aid dispensed

· Dispensing fees require authorization whenever the hearing aid requires authorization

The dispensing fee is a professional service. Do not use modifier NU when billing the dispensing fee.