BlueCross BlueShield of Tennessee Medical Policy Manual

General Policy on Hearing Impairment

PURPOSE

To determining appropriate testing and treatment of individuals with hearing loss.

DESCRIPTION

Hearing impairment or hearing loss is a reduction in the ability to perceive sound. The loss may range from slight to complete deafness.

POLICY

• BlueCross BlueShield of Tennessee recognizes the need for consistency in the determination of medical appropriateness for testing and treatment of hearing loss.

• Services will be considered medically appropriate only if they have met BlueCross BlueShield of Tennessee's technology evaluation criteria.

********* THE FOLLOWING POLICIES HAVE BEEN *********

REVIEWED. PLEASE REFER TO THE POLICY

********* TO DETERMINE MEDICAL APPROPRIATENESS. *********

DIAGNOSTICS:

• Acoustic Immittance Measures for Hearing

• Conditioning Play Audiometry for Hearing

• Dynamic Posturography in the Assessment of Balance

• Electrocochleography (ECochG)

• Evoked Otoacoustic Emissions (OAE)

• Pure-Tone Audiometry

• Select Picture Audiometry

• Visual and Auditory Evoked Potentials

• Visual Reinforcement Audiometry (VRA) for Hearing

THERAPEUTICS:

• Cochlear Implant

• Laser Assisted Myringotomy

• Tinnitus Retraining Therapy (TRT) and Tinnitus Maskers for the Treatment of Tinnitus

• Transtympanic Micropressure Applications as a Treatment of Ménière's Disease

ORIGINAL EFFECTIVE DATE:  10/1998

MOST RECENT REVIEW DATE:  4/18/2011

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.