Conditioning Play Audiometry for Hearing
DESCRIPTION
Conditioning play audiometry (CPA) is a type of audiometric study used as a diagnostic test to evaluate hearing loss. CPA is a standard battery test that is considered to be part of the initial work-up for children, age two (2) to four (4) years of age with hearing impairment. It is a form of instrumental/operant conditioning in which a child is taught to wait and listen for a stimulus. The child is then to respond by performing a motor task in response to the stimulus. For example, the child is taught to put an object in a specific place, (e.g., a marble in a box or a cow in the barnyard) when a specific sound is heard.
POLICY
Conditioning play audiometry for the diagnosis and evaluation of hearing impairment is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
See also:
MEDICAL APPROPRIATENESS
Conditioning play audiometry for the diagnosis and evaluation of hearing impairment is considered medically appropriate if ALL of the following criteria are met:
The child is age two to four (2 - 4)
The child has no other developmental or physical impairment
ANY ONE of the following conditions exist:
Bacterial meningitis
Cochlear otosclerosis
Congenital anomalies
Exposure to intense noise
Facial nerve paralysis (Bell's Palsy)
Fractures of the temporal bone or trauma affecting the central auditory pathways
Hearing loss
Labyrinthitis
Ménière's disease
Neoplasms of the auditory or central nervous system
Otitis media
Ototoxic drugs
Surgery involving the auditory and/or central nervous system (e.g., skull-based tumors such as acoustic neuroma and meningioma)
Tinnitus
Vertigo (dizziness)
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
American Academy of Otolaryngology-Head and Neck Surgery. (2011, April). Children’s hearing health. Retrieved November 18, 2011 from http://www.entnet.org/HealthInformation/childshearing.cfm.
American Academy of Pediatrics. (2009). Clinical report - Hearing assessment in infants and children: Recommendations beyond neonatal screening. Pediatrics, 124 (4), p. 1252-1263.
American Speech and Language Association. (2004). Guidelines for the audiologic assessment of children from birth to 5 years of age. Retrieved December 3, 2008 from http://search.asha.org/query.html?col=asha&col=ashfoun&col=nsslha&qt=guidelines%20for%20audiologic%20screening.
American Speech-Language-Hearing Association. (2011). Pure-Tone Testing. Retrieved November 17, 2011 from http://www.asha.org/public/hearing/Pure-Tone-Testing/.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment (9.01.02). Retrieved November 18, 2011 from BlueWeb. (6 articles and/or guidelines reviewed)
Code of Federal Regulations (CFR) 45 C.F.R. § 1308.21- Subpart G--Parent Involvement Performance Standards. October 2007. P. 170-186. Retrieved December 4, 2008 from http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=40143522876+79+2+0&WAISaction=retrieve.
U. S. Preventive Services Task Force. (2008). Universal screening for hearing loss in newborns. Retrieved November 17, 2011 from http://www.uspreventiveservicestaskforce.org/uspstf08/newbornhear/newbhearrs.htm.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 1/12/2012
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.