Pure-Tone Audiometry
DESCRIPTION
Pure-tone audiometry, air and bone conduction tests are standard audiometric studies that utilize tones of various frequencies and intensities as auditory stimuli to measure hearing. Air conduction is the usual method of sound transmission; air conduction utilizes the external and middle ear in the transmission of sound to the cochlea and beyond. Bone conduction involves the vibration of the skull by direct contact with an oscillating device, which is thought to set the cochlear fluids into motion, bypassing the external and middle ear. When bone conduction thresholds are better than air conduction thresholds, the hearing loss is conductive. When bone conduction thresholds are the same as air conduction thresholds, the hearing loss is sensorineural. When bone conduction thresholds are reduced but are still better than air conduction's, the loss is mixed or combined.
POLICY
Pure-tone audiometry, air and bone conduction testing to determine if and what kind of hearing loss is present in children 3 years old and older, and in adults, is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
See also:
MEDICAL APPROPRIATENESS
Pure-tone audiometry, air and bone conduction testing to determine if and what kind of hearing loss is present in children 3 years old and older and in adults with illnesses or injuries is considered medically appropriate for, but not limited to, ANY ONE of the following conditions:
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
110th Congress: 2nd Session: H. R. 1198: (2008, April). Early hearing detection and intervention act of 2008 (referred to Senate committee after being received from House). Retrieved October 30, 2008 from http://thomas.loc.gov.
American Academy of Pediatrics. (2003). Clinical report. Hearing assessment in infants and children: Recommendations beyond neonatal screening. Pediatrics, 111 (2), 436-440.
American Academy of Pediatrics. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120 (4), 898-921.
American Speech and Language Association. (2004). Guidelines for the audiologic assessment of children from birth to 5 years of age. Retrieved October 30, 2008 from http://www.asha.org/NR/rdonlyres/0BB7C840-27D2-4DC6-61B-1709ADD78BAF/0/v2GLAudAssessChild.pdf.
American Speech and Language Association. (2005). Guidelines for manual pure-tone threshold audiometry. Retrieved October 31, 2008 from http://www.asha.org/docs/pdf/GL2005-00014.pdf.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment. (9.01.02). Retrieved July 20, 2011 from BlueWeb. (6 articles and/or guidelines reviewed)
Boatman, D. F., Miglioretti, D. L., Eberwein, C., Alidoost, M., & Reich, S. G. (2007). How accurate are bedside hearing tests? Neurology, 68 (16), 1311-1314.
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, April). Audiology services (80.3, p. 4-240 to 4-233). Ingenix.
Katbamna, B., Crumpton, T., & Patel, D. L. (2008). Hearing Impairment in Children. Pediatric Clinic of North America, 55 (5) 1175-1188.
Mulheran, M. Hyman-Taylor, P., Tan, K. T., Lewis, S., Stableforth, D., Knox, A., et al. (2006). Absence of cochleotoxicity measured by standard and high-frequency pure tone audiometry in a trial of once- versus three-times-daily tobramycin in cystic fibrosis patients. Antimicrobial Agents and Chemotherapy, 50 (7), 2293-2299. (Level 1 Evidence - Industry sponsored)
National Guideline Clearinghouse. (2003). Hearing assessment in infants and children: Recommendations beyond neonatal screening. Retrieved October 30, 2008 from http://www.guideline.gov/summary/summary.aspx?doc_id=3614&nbr=002840&string=audiometry.
U. S. Food and Drug Administration. (June, 2006). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K060883. Retrieved October 31, 2008 from. http://www.fda.gov/cdrh/pdf6/K060883.pdf.
U. S. Food and Drug Administration. (March, 2007). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070118. Retrieved October 31, 2008 from http://www.fda.gov/cdrh/pdf7/K070118.pdf.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 9/22/2011
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.