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
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.