|
Notable technological developments have been made in the field of implantable hearing aids. Apart from the more commonly employed cochlear implant technology, there has been growth in the use of middle-ear implants (MEI) and, more recently, bone-anchored hearing aids (BAHA) suitable for single-sided hearing loss.
As technology advances, the role of audiologists expands in kind. Audiologists play a pivotal role in evaluating the advantages and disadvantages of these new technologies and guiding their patients in reaching individual decisions.
With health plans offering little, if any, coverage for external hearing aids, ASHA has received calls from members and consumers as to the likelihood of insurance coverage for these new implantable devices. The following questions and answers address common concerns.
What are implantable hearing aids?
A. Implantable hearing aids comprise two subgroups: BAHA and MEI. Both require surgery and both require that some portion, or an entire device, be implanted either behind the ear in the mastoid area (BAHA) or in the middle-ear cavity (MEI). Other than these two common points, these implantable aids differ in function and use. The BAHA is used for those with conductive or mixed hearing loss, while the MEI is used most often for those with sensorineural hearing loss (Chasin, M. [2002]. Bone anchored and middle ear implant hearing aids. Trends in Amplification, 6[2]).
Are cochlear implants considered to be implantable hearing aids?
A. The Centers for Medicare and Medicaid Services (CMS) issued Transmittal 1781 on Nov. 22, 2002, which states that cochlear implants are not defined as hearing aids for the purpose of Medicare payment policy because cochlear implants produce as their output an electrical signal that directly stimulates the auditory nerve. Hearing aids, on the other hand, both external and implantable, use functional air and/or bone conduction pathways to facilitate hearing.
Private health plans often establish their own definitions, so it is important to check with the plan in question to ascertain how they define cochlear implants.
Do health plans pay for BAHA and/or MEI?
A. Medicare does not pay for BAHA or MEI, as they are defined as hearing aids for the purposes of Medicare payment policy and Medicare does not reimburse for hearing aids. In November, CMS clarified in a change request (#2256) to the Medicare Carriers Manual that a hearing aid is any device that does not produce as its output an electrical signal that directly stimulates the auditory nerve. This change request was issued specifically to address implantable hearing aids and to reiterate CMS’ policy (42 CFR 411.15) that "hearing aids or examinations for the purpose of prescribing, fitting or changing hearing aids" are excluded from coverage under the Medicare program.
Private health plans establish their own coverage policies; therefore, it is recommended that the audiologist contact the provider relations staff for the specific health plan in question to determine their coverage of BAHA or MEI. ASHA has learned that some private health plans specifically exclude implantable hearing aids from coverage (e.g., Federal Blue Cross Blue Shield), while others cover the devices when very specific criterion has been met (e.g., Aetna).
Medicaid is a jointly funded program between the state and federal governments. While hearing aids are mandated when medically necessary under the Early Periodic Screening Detection and Testing program, states are permitted to develop their own coverage policies. To determine state-specific Medicaid coverage of implantable hearing aids, contact your state Medicaid agency. Visit http://www.cms.hhs.gov/RegionalOffices/ for a list of state Medicaid office contacts.
Are there codes for implantable hearing aids?
A. Yes. The American Medical Association (AMA) CPT Editorial Panel approved a series of Level I HCPCS codes (Healthcare Common Procedure Coding System; HCPCS codes were developed by CMS for reporting most medical services and supplies) for the surgical procedures associated with implantable hearing aids. The AMA Relative Value Update Committee then assigned relative value units to the codes. These codes may be reimbursed by Medicaid and private health plans, but not by Medicare for the reasons outlined above. The HCPCS codes were included in the Nov. 30, 2001, Federal Register (42 CFR Parts 413, 418, 439). Visit www.access.gpo.gov/su_docs/fedreg/a011130c.html and scroll down to "Centers for Medicare and Medicaid Services, Rules, Hospital Outpatient Payment Perspective Payment System" to access this Document.
The HCPCS codes* are:
- 69714—Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
- 69715—Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy
- 69717—Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
- 69718—Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy.
For further clarification, contact Maureen Thompson by e-mail at mthompson@asha.org.
* CPT and HCPCS codes, ©American Medical Association, all rights reserved.
|