Bone-Anchored Hearing Aids — CPB 0403 | AETNA Coverage Update

Aetna modified CPB 0403 for bone-anchored hearing aids (BAHAs), effective September 26, 2025. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its BAHA coverage policy under CPB 0403 Aetna system, clarifying medical necessity criteria for fully and partially implantable bone-anchored hearing aids and temporal bone stimulators. The affected codes span 12 covered surgical CPT codes — including 69710, 69714, 69716, and 69729 — plus HCPCS codes L8690 through L8694 for the devices themselves. If your practice or ASC bills BAHA implants for Aetna members in 2025 or 2026, this update directly affects your claim documentation.

Quick-Reference Table

Aetna Bone-Anchored Hearing Aid Coverage Criteria and Medical Necessity Requirements 2025

The Aetna BAHA coverage policy classifies BAHAs as medically necessary prosthetics — not elective devices — when the patient meets all of the following conditions.

Age threshold: The patient must be 5 years old or older. Aetna does not cover BAHA implants for children under five. If your practice treats pediatric patients, this is the first gate your documentation must pass.

Hearing loss type: The patient must have a unilateral or bilateral conductive hearing loss, or a mixed conductive and sensorineural hearing loss. Pure sensorineural hearing loss alone does not qualify under this coverage policy.

Air-conduction failure: The patient's condition must prevent restoration of hearing using a conventional air-conductive hearing aid. This is a hard requirement. Your clinical documentation needs to spell this out explicitly — not just imply it.

Qualifying conditions (at least one must apply):

The real issue here is documentation depth. Aetna wants to see that a conventional hearing aid was considered and ruled out. A chart note that says "patient unable to use conventional hearing aid" is not enough. You need the specific clinical reason — aural atresia, chronic otitis, dermatitis, or a documented contraindication — tied to one of the six criteria above.

Prior authorization: BAHAs involve surgical implantation under CPT codes like 69714 (percutaneous osseointegrated implant, temporal bone) and 69716 (skull implant with magnetic transcutaneous attachment). Procedures at this level almost always carry prior authorization requirements on Aetna commercial and managed care plans. Confirm PA requirements for the specific plan before scheduling. A single claim denial on a BAHA can run thousands of dollars in lost reimbursement.

Audiology testing — CPT 92551 through 92586 and related audiologic function codes — also falls in the related code set. Aetna expects audiologic criteria to be met. Make sure your audiology documentation is in the chart before the surgical claim goes out.

Coverage Indications at a Glance

Aetna Bone-Anchored Hearing Aid Billing Guidelines and Action Items 2025

The effective date for this modified policy is September 26, 2025. Treat that as your audit trigger date. If you have claims in process or scheduled cases for BAHA patients, run through this list now.

CPT, HCPCS, and ICD-10 Codes for Bone-Anchored Hearing Aids Under CPB 0403

Covered CPT Codes — When Selection Criteria Are Met

Covered HCPCS Codes — When Selection Criteria Are Met

Other CPT Codes Related to CPB 0403

These codes are not BAHA implant codes, but Aetna includes them in the policy's related code set. They appear in the diagnostic workup, related surgical history, or auditory rehabilitation context.

Other HCPCS Codes Related to CPB 0403

The ICD-10-CM code set for this policy is extensive — 428 codes in total, spanning congenital malformations of the ear, otosclerosis, chronic otitis media, external ear conditions, and neoplasms of the ear canal and tympanic cavity. Pull your full ICD-10 list directly from the CPB 0403 Aetna policy document. Map your diagnosis codes against the specific qualifying condition you're documenting. Using a valid but imprecise ICD-10 code — one that doesn't directly support the qualifying indication — is a common cause of BAHA claim denials that would otherwise be avoidable.