November 1, 2013 Departments

Policy Analysis: CMS Approves Bilateral Baha for Children

ASHA asks for a billing change based on compelling evidence of better outcomes with bilateral, rather than unilateral, hearing systems.

A change to Medicare and Medicaid rules will allow infants and children with conductive hearing loss in both ears to obtain bilateral softband bone anchored hearing aid (Baha®) systems.

A billing rule in effect since July 1, 2012, limited softband Baha to one unit per day per patient, meaning a child could receive the system for only one ear. The rule was part of the Centers for Medicare and Medicaid Services' National Correct Coding Initiative, which is designed to ensure correct coding for billing and to reduce inappropriate payments.

ASHA successfully advocated for the NCCI change, presenting evidence confirming the advantage of bilateral over unilateral Baha for understanding speech in quiet and in noise. The evidence, outlined in asystematic review of the literature published in the Otolaryngology-Head and Neck Surgery, also indicates that bilateral Baha improves localization and lateralization, and that users have a higher satisfaction with the bilateral devices.

Baha uses bone conduction transmission to bypass the middle ear and stimulate the cochlea. The implanted version consists of a titanium implant, an external abutment and a detachable sound processor. However, implantation is approved only for patients at least 5 years old, based on the need for mastoid maturation. For children who are not surgical candidates, the external sound processors are connected to an elastic headband with snap connectors, called a softband. Softbands can hold two processors for the ideal binaural hearing condition, offering the ideal language development conditions.

After evaluating the ASHA-supplied literature review from the otolaryngology journal and other compelling evidence supporting binaural hearing, CMS increased the limit from one to two units, retroactive to the effective date of the rule (July 1, 2012). The changes will appear in the January version of the NCCI edits. Medicaid claims for two units submitted since then that were denied because of the rule can be appealed.

It is important to note that the Medicaid programs can implement their own policies regarding eligibility for bilateral Baha, but cannot deny coverage based on the billing rule.

Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy.

cite as: Satterfield, L. (2013, November 01). Policy Analysis: CMS Approves Bilateral Baha for Children. The ASHA Leader.


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