BAHA Procedure Code Details

Code -  L8692

Description - New. Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.

PAR - Always

Required PAR and Claim Modifier - UB 

Allowed Billing Provider Types -  Physician, Pharmacy, Supply, Clinics, Osteopath, Audiologist.

Allowed Rendering Provider Types - Physician, Osteopath, Audiologist

Code -  L8691

Description - Replacement. Auditory osseointegrated device, external sound processor.

PAR - Always

Required PAR and Claim Modifier - UB 

Allowed Billing Provider Types -  Physician, Pharmacy, Supply, Clinics, Osteopath, Audiologist.

Allowed Rendering Provider Types - Physician, Osteopath, Audiologist

Specific Non-Covered Benefits

• Training or consultation provided by an Audiologist to an agency, facility, or other institution is not covered
• The upgrading of an existing cochlear implant system or component if the existing unit is properly functioning is not covered 
• Hearing aids for adults (Hearing exams and evaluations are a benefit for adults only when a concurrent medical condition exists) are not covered 
• Hearing aid insurance is not covered 
• Any service not documented in the member's plan of care is not covered
• Ear molds for the purpose of noise reduction or swimming are not covered 
• Any audiological services rendered by a non-licensed audiologist (except for licensed otolaryngologists and enrolled CHIP providers, are not covered 

Prior Authorization Requests (PARs) 

Although most procedures can be processed without prior review and approval, certain procedures require prior authorization. A list of authorizing agencies, addresses, and telephone numbers is located in Appendices C and D in the Appendices of the Provider Services Billing Manuals section of Department’s Web site. Selected surgical procedures and all services provided outside of Colorado, with the exception of emergency services, require prior authorization. Providers must complete, submit, and receive approval of the Prior Authorization Request (PAR) before rendering the service or supply.

Electronic PAR submission offers the provider:

•  Immediate system assignment of a PAR number
•  Faster PAR processing 

Only Dental Care, Medical Care, and Supply PARs may be submitted electronically through the Web Portal, but all PAR type responses are available for inquiry. PARs submitted to the fiscal agent by paper must be submitted on the correct PAR form using the national Centers for Medicare and Medicaid Services (CMS) and Current Procedural Terminology (CPT) codes described in this manual. PARs submitted to the fiscal agent without utilizing the Healthcare Common Procedural Coding System (HCPCS) codes or on the incorrect form will not be accepted. Paper PAR forms and completion instructions are located in the Provider Services Forms section.

Approval of a PAR does not guarantee Colorado Medical Assistance Program payment and does not serve as a timely filing waiver. Prior authorization only assures that the service is considered a benefit of the Colorado Medical Assistance Program. All claims, including those for prior authorized services, must meet eligibility and claim submission requirements (e.g. timely filing, Primary Care Physician (PCP) information completed appropriately, third party resources payments pursued, required attachments included, etc.) before payment can be made. 

After a PAR has been reviewed, a PAR letter is sent to the provider and the member. For approved services, allow sufficient time for the fiscal agent to enter the PAR data into the Colorado Medical Assistance Program processing system before submitting a claim for the authorized service.