Bone Conduction
by Jamie Schwartz

Adults with mixed or conductive hearing loss: solutions all clinicians need to know

January 30, 2018
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As a treatment option for hearing loss the Baha system is more successful than middle ear surgery or hearing aids.1

For adult patients with mixed or conductive hearing loss a bone conduction hearing solution may be the best treatment option. Through bone conduction, sound is conducted naturally through the bone directly to the cochlea, independent of the outer and middle ear. The Cochlear™ Baha® System leverages this natural process by amplifying sound signals, converting them into vibrations and transmitting them to an implant anchored in the temporal bone. Implantable bone conduction is, therefore, an effective hearing solution for people with conductive or mixed hearing loss because it bypasses any problems associated with the outer or middle ear. Many hearing care professionals agree that for these types of problems, the Baha system is a more effective solution than air conduction devices.2 Part of what makes the Baha System unique is that patients can test it out before they commit to surgical implantation.

Candidacy

Candidacy evaluation for an implantable bone conduction system includes audiological testing as well as a personal trial with the Baha System. The patient’s air-bone gap can be a guide to the benefits that can be expected from choosing a Baha System. Comparing the results of speech testing in sound field, with and without the sound processor, can also be useful.

Some recommended tests for mixed and conductive hearing loss include:

  • Pure tone audiometry
  • Listening test
  • Speech audiometry

Evaluation

When evaluating adult patients with mixed or conductive hearing loss, an important consideration is the type of medical condition that has caused the hearing loss. For some indications, such as chronic otitis media and allergies, an implantable bone conduction may be the only feasible solution,3-5 regardless of the size of the air-bone gap.

Some common causes of mixed and conductive hearing loss include:

  • Atresia/Microtia
  • Allergies (serous otitis media)
  • Cholesteatoma
  • Chronic mastoiditis/mastoid cavity
  • Chronic Suppurative Otitis Media
  • Congenital aural atresia
  • Draining ears
  • Ear canal stenosis
  • External otitis
  • Genetics
  • Otosclerosis
  • Other middle ear dysfunctions

Treatment

When treating a patient with mixed or conductive hearing loss, the first line of treatment is middle ear surgery and/or hearing aids. If the first line treatments are not successful, the suggested second line treatment is an implantable bone conduction system. A recent research survey of 29 clinicians that use the Baha system as a treatment option for hearing loss shows that the Baha system is more successful than the first line of treatment.1

Patients with mixed or conductive hearing loss may benefit from a Baha System. Patients with mixed or conductive hearing loss performed better in noise with a Baha system than an acoustic hearing aid and 82% (27/33) of users prefer a Baha sound processor to a power hearing aid.6

If you are interested in bringing the Baha system into your clinical practice, please reach out to your Cochlear Field Team today. Don’t know who your Field Team members are?  Call: 1-800-523-5798 or 303-790-9010 and we can connect you today!

If you are already a Baha provider, please right-click and save the infographic below to use during counseling.

Hearing Loss Baha

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References:
  1. Cochlear Baha: Patient Research [Data on file] 2017 June.
  2. Snik AF, Mylannus EA, Proops DW, et al. Consensus statements on the BAHA system where do we stand at present? The Annals of Otology, Rhinology & Laryngology 2005; 195:1-12.
  3. Hol MK, Snik AF, Mylanus EA, Cremers CW. Long-term results of boneanchored hearing aid recipients who had previously used air-conduction hearing aids. Archives of Otolaryngol Head Neck Surg. 2005;131(4):321-5.
  4. McDermott AL, Dutt SN, Reid AP, Proops DW. An intra-individual comparison of the previous conventional hearing aid with the boneanchored hearing aid: The Nijmegen group questionnaire. J Laryngol Otol. 2002;116 Suppl. 28:15-9.
  5. De Wolf MJ, Hedrix S, Cremers CW, Snik AF. Better performance with bone anchored hearing aid than acoustic devices in patients with severe air-bone gap. Laryngoscope. 2011;121:613-16
  6. Mylanus EAM, van der Pouw KCTM, Snik AFM, Cremers CWRJ. Intraindividual Comparison of the Bone-Anchored Hearing Aid and Air-Conduction Hearing Aids. Arch Otolaryngol Head Neck Surg. 1998;124(3):271–276. doi:10.1001/archotol.124.3.268
Author

Jamie Schwartz

Jamie is the Associate Marketing Manager in the Product and Professional Marketing Department at Cochlear Americas. Jamie is responsible for ProNews blog content as well as professional social posts and calendars. If you are interested in being a guest author for the ProNews blog please contact Jamie by email at jschwartz@cochlear.com.

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Interview with Melissa Tumblin: Advocating for Ally’s Act

March 5, 2020

Introducing Ally’s Act, H.R. 5485

Interview with Melissa Tumblin, Founder and Executive Director of the Ear Community Organization

Cochlear: Who is Ally? 
Melissa Tumblin: My daughter, Ally Tumblin, is a 10 year-old girl from Broomfield, CO who was born with microtia and aural atresia of her right ear. Ally wears a bone anchored hearing device to help restore her significant conductive hearing loss. She is now an advocate for the deaf/hard-of-hearing (D/HOH) community, especially for the microtia and atresia community.

Wanting to advocate during Better Hearing and Speech Month in May 2019, she wrote to Congressman Joe Neguse (D-CO) asking for help and he responded! As a result, Congressman Neguse introduced Ally’s Act, H.R.5485 honoring Ally and her advocacy to help others obtain hearing device insurance coverage for hearing implants through private insurers.

Cochlear: What is Ally’s Act?
Melissa Tumblin: Ally’s Act, H.R. 5485 is a bipartisan national bill that would ensure that private insurance companies provide coverage for hearing devices including osseointegrated hearing devices (OIDs) like bone anchored hearing aids and cochlear implants as well. Ally’s Act is not a state-level bill, which means the legislation would help children and adults by ensuring that these hearing devices have coverage in every state, unlike the current situation where hearing device coverage varies from state to state. In fact, only half of our states have legislation in place to cover hearing aids. Even with this coverage in place, bone conduction hearing aids and cochlear implants are not always included in these coverage plans.

Once passed, Ally’s Act may allow or enhance access to these important devices by covering:


1. A bone conduction hearing aid or cochlear implant
2. An upgrade replacement of these hearing devices every five years
3. Accessories including Soft Band headband, hard headband and adhesives
4. Repairs for these devices
5. One comprehensive hearing assessment per year
6. One preoperative assessment per year
7. Implantation surgery
8. Postoperative medical appointments for purposes of ensuring appropriate recovery from surgery
9. Postoperative audiological appointments for activation, fitting and programming
10. Aural rehabilitation services related to the use of this device

Congressman Neguse, who introduced H.R. 5485, states, “This bill would ensure that insurance coverage for hearing devices such as [hearing implants] be consistent and fair, to ensure every child can thrive and obtain the hearing healthcare they deserve.” Ally’s Act, H.R. 5485 would help these individuals obtain consistent hearing device coverage in every state through private insurers identified in the Affordable Care Act.

Cochlear: How do you wish to partner with professionals and how can they support Ally’s Act?
Melissa Tumblin: Many medical professionals have encountered patients who have had claims denied by private insurance providers when trying to obtain hearing implants. These professionals now have the chance to take action – hearing health professionals such as ENTs/otolaryngologists, audiologists, speech and language pathologists, teachers of the D/HOH, school district educators and interpreters have the opportunity to write and call their local representatives about Ally’s Act.

They can also reach out to their professional organizations to support this important piece of legislation. Lastly, these medical professionals and supporting organizations who have endorsed Ally’s Act can also schedule appointments and speak with their local representatives in person to support passage of the legislation.

Cochlear: How could Ally’s act impact the hearing industry as a whole?
Melissa Tumblin: Ally’s Act helps raise awareness of implantable solutions and advocates for the insurance coverage needed to increase access to these devices. This impacts the accessibility of hearing implants in general.

Moreover, Ally’s Act educates law makers about what is needed to improve hearing health care by hearing directly from medical professionals, the impacted families and adults who wear hearing implants. In fact, this could also educate the involved insurance companies. Ally’s Act may even pave the way for better hearing health care bills down the road!

Cochlear: What do you need from the public to help get Ally’s Act approved?
Melissa Tumblin: After introduction, this piece of legislation must pass through the House and the Senate and be signed by the President of the United States before becoming law. To aid this process, we must rely on the community to support this bill. I encourage anyone with a vested interest in healthcare to write to and call their local representatives, asking them to co-sponsor Ally’s Act.

In addition, community members can write to the House Committee for Energy and Commerce and call the members who sit on this committee. If there is not a House member who sits on this committee representing your state, they can then write to and call Chairman Frank Pallone. Even though the act may need 290 co-sponsors, this number is not always the deciding factor that could help move this bill out of the House Committee. The quality of letters and calls, along with following up with the offices of the representatives that have been contacted make a difference.

To stay updated on the status of Ally’s Act, H.R. 5485 please visit the Congressional website.

About Melissa Tumblin:

Melissa founded Ear Community ten years ago after her youngest daughter, Ally, was born. Ear Community is the first parent-driven nonprofit organization that directly helps children and adults who are born with microtia and aural atresia. It cultivates a community focused on education, awareness and support. Ear Community donates bone anchored hearing devices to individuals who have been denied coverage for these devices and awards college scholarships.

In the United States and Canada, the placement of a bone-anchored implant is contraindicated in children below the age of 5

New Codes for AOI Fitting Services: Five Steps to Prepare for 2024

November 28, 2023

Effective January 1, 2024, audiologists who program auditory osseointegrated implant (AOI) devices will have two newly established Current Procedural Terminology (CPT©, American Medical Association) codes to report their services. 

CPT Codes 92622 and 92623 have established service descriptors and assigned Relative Value Units (RVUs), allowing professionals a predictable pathway for reimbursement of services rendered. 

CPT 92622: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes

CPT 92623: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes

Five recommendations to prepare:

  1. Familiarize yourself with the new codes and descriptors so you know when and how to use them. 
    1. Update the clinic’s superbill to include these new codes. If you are unfamiliar with superbills or would like to review templates, ASHA, AAA, and ADA offer resources and templates which you may find useful.
    1. Educate and coordinate with billing staff, billing software vendors, or Electronic Data Interchange (EDI) clearinghouse to ensure they are also aware of and ready for claims with the new service codes.
  2. Establish charges for the new codes and services which align with the clinic’s pricing protocol and policy and procedures.
    • While healthcare professionals have discretion to charge appropriate amounts for their services, charges should remain consistent, regardless of type of payment or patient’s insurance status.
  3. Review/Update your clinic’s billing procedures.
    • Prior to the appointment:
      • Confirm patient information, insurance information, and coverage details. 
      • Verify coverage of services by health plans and potential prior authorization requirements.
      • Confirm/inform patients of any financial responsibility and consider collecting copayments at the appointment.
    • After the appointment:
      • Complete notes and documentation of services rendered to support medical necessity of care.
      • Include a clear description reflecting the time associated with the services.
      • Capture relevant information on superbill or in billing software to prepare claims for filing.
  4. Complete a claims review to ensure payers process claims appropriately. 
    • Track the initial claims with these new CPT codes across insurance payers using the new AOI fitting codes.
    • Compare allowed amounts for covered services to fee schedules/negotiated contracted rates.
    • Review the remittance advice to understand any denial reasons, and file appeals when pathways are available.
  5. Follow up with any payers if new CPT codes have not been uploaded in their annual update.
    • Share a written request for adoption of codes within the audiology code set.  Provide a summary of the CPT code(s), descriptor(s), and service(s) included.
    • Appeal any denials for non-covered services based on the CPT code reported. 

For any questions or additional resources, please reach out to your Cochlear Market Access & Payer Strategy (MAPS) Manager. You can locate your regional manager’s contact information here: MAPS Manager Contact Information

All specific references to CPT codes and descriptions are ©2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. CPT and CPT material are copyrights of American Medical Association (AMA): CPT Copyright 2020 American Medical Association, all rights reserved. CPT is a registered trademark of the American Medical Association.  

The information provided in this document is provided as guidelines only to address the unique nature of implantable hearing solutions technology. This information does not constitute reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding this information or its completeness, accuracy, fitness for any purpose, timeliness, or that following these guidelines will result in any form of coverage or reimbursement from any insurance company or federal health care program payer. The information presented herein is subject to change at any time. This information cannot and does not contemplate all situations that a health care professional may encounter. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement and coding needs and the proper implementation of these guidelines. All products should be used according to their labelling. In all cases, services billed must be medically necessary, actually performed, and appropriately documented in the medical record.  

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©Cochlear Limited 2024. All rights reserved. ACE, Advance Off-Stylet, AOS, Ardium, AutoNRT, Autosensitivity, Baha, Baha SoftWear, BCDrive, Beam, Bring Back the Beat, Button, Carina, Cochlear, 科利耳, コクレア, 코클리어, Cochlear SoftWear, Contour, コントゥア, Contour Advance, Custom Sound, DermaLock, Freedom, Hear now. And always, Hugfit, Human Design, Hybrid, Invisible Hearing, Kanso, LowPro, MET, MP3000, myCochlear, mySmartSound, NRT, Nucleus, Osia, Outcome Focused Fitting, Off-Stylet, Piezo Power, Profile, Slimline, SmartSound, Softip, SoundArc, True Wireless, the elliptical logo, Vistafix, Whisper, WindShield and Xidium are either trademarks or registered trademarks of the Cochlear group of companies. The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

 

This material is intended for health professionals. If you are a consumer, please seek advice from your health professional about treatments for hearing loss. Outcomes may vary, and your health professional will advise you about the factors which could affect your outcome. Always read the instructions for use. Not all products are available in all countries. Please contact your local Cochlear representative for product information.

 

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