DESCRIPTION
Evoked otoacoustic emissions involve the measurement of sounds in the external ear canal that reflect the working of the cochlea. A probe and click stimuli is utilized in the performance of this test. OAE is considered a standard battery test used to screen for hearing impairment in infants. It is considered a specialized test when used to test for hearing impairment in adults and children.
POLICY
Evoked otoacoustic emissions used to screen for hearing impairment in infants (birth through 24 months) is considered medically necessary.
Evoked otoacoustic emissions used to test for hearing impairment in adults and children is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Evoked otoacoustic emissions testing is considered medically appropriate for adults and children when the initial diagnostic tests are inconclusive or with illnesses or injuries including, but not limited to, the following:
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
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.
ADDITIONAL INFORMATION
The following screening program for infants is recommended by the American Academy of Pediatrics 2007 Position Statement:
Begin screening for hearing loss no later than one month of age
Include a comprehensive audiological evaluation before three months of age for infants who fail the initial screen
Refer infants with confirmed hearing loss for age-appropriate diagnostic testing before six months of age
Refer infants for effective intervention by qualified professionals with an expertise in hearing loss and deafness in infants and children
Well-child visits should Include ongoing surveillance of communicative development beginning at two months of age regardless of previous hearing-screening outcomes or the presence of risk factors
SOURCES
American Academy of Pediatrics. Policy Statement. (2007). Year 2007 Position Statement: Principles and guidelines for early hearing detection and intervention programs. Retrieved October 12, 2007 from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/2/527.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment (9.01.02). Retrieved October 12, 2007 from BlueWeb. (6 articles and/or guidelines reviewed)
BlueCross BlueShield of Tennessee network physicians. February 2008.
Hayes. Medical Technology Directory. (2005, July). Neonatal hearing screening. Retrieved October 12, 2007 from https://www.hayesinc.com/subscribers/subscriberArticlePDF.pdf?articleId=3255. (62 articles and/or guidelines reviewed)
National Institutes of Health. Consensus Statements. (1993). Early identification of hearing impairment in infants and young children. Retrieved May 28, 2003 from http://consensus.nih.gov/cons/092/092_statement.htm.
U. S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed., pp. 395-396). Baltimore: Williams & Wilkins.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 5/10/2008
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.