BlueCross BlueShield of Tennessee Medical Policy Manual

Select Picture Audiometry

DESCRIPTION

Select picture audiometry is form of testing used to evaluate hearing-impaired children. It involves the use of picture cards and the child's ability to correctly identify objects based on audiological direction.

POLICY

Select picture audiometry when used to test hearing impairment in children and non-English speaking individuals is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)

See also:

• Acoustic Immittance Measures for Hearing

• Conditioning Play Audiometry for Hearing

• Evoked Otoacoustic Emissions (OAE)

• General Policy on Hearing Impairment

• Pure-Tone Audiometry

• Visual and Auditory Evoked Potentials

MEDICAL APPROPRIATENESS

Select picture audiometry is considered medically appropriate for, but not limited to, any 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).

 ADDITIONAL INFORMATION

Select picture audiometry is not preferred when testing infants.

SOURCES

American Academy of Pediatrics. (2007). Year 2007 Position Statement: Principles and guidelines for early hearing detection and intervention programs. Retrieved January 14, 2008 from http://aappolicy.aappublications.org/cgi/reprint/pediatrics;120/4/898.pdf.

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment (9.01.02). Retrieved February 11, 2008 from BlueWeb. (6 articles and/or guidelines reviewed)

Combs, J. T, Waterman, S. A., & Combs, M. K. (1996). Select picture audiometry in an office setting. Clinical Pediatrics, 35 (3), 161-164.

National Guideline Clearinghouse. (2003, February). Hearing impairment in infants and children: Recommendations beyond neonatal screening. Retrieved January 14, 2008 from PubMed database.

ORIGINAL EFFECTIVE DATE:  10/1998

MOST RECENT REVIEW DATE:  3/27/2008   

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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.