Prior authorization is required for a BAHA. Prior authorization consideration will be given if the client is 5 years of age or older if all of the following documentation is provided:
•Previous attempts at hearing aids and why these devices are inadequate or have failed.
•Scores on hearing tests for bone conduction thresholds and on maximum speech discrimination.
•Audiological testing showing good inner ear function.
•Assessment that shows the client is motivated, is able to follow given instructions, and is willing to participate in follow-up therapy.
•Appropriate diagnosis including, but not limited to the following:
Diagnosis Code
Description
1601
Malignant neoplasm of auditory tube, middle ear, and mastoid air cells
1710
Malignant neoplasm of connective and other soft tissue of head, face, and neck
1732
Other malignant neoplasm of skin of ear and external auditory canal
2120
Benign neoplasm of nasal cavities, middle ear, and accessory sinuses
2150
Other benign neoplasm of connective and other soft tissue of head, face, and neck
2162
Benign neoplasm of ear and external auditory canal
2322
Carcinoma in situ of skin of ear and external auditory canal
38032
Acquired deformities of auricle or pinna
38110
Simple or unspecified chronic serous otitis media
38120
Simple or unspecified chronic mucoid otitis media
3813
Other and unspecified chronic nonsuppurative otitis media
Previous attempts at hearing aids and why these devices are inadequate or have failed.