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CMS Upholds Osseointegrated Implant Benefit

CMS Upholds Osseointegrated Implant Benefit

November 04, 2014 Government Relations News

The audiology and hearing health communities received great news on Friday, October 31st, when the Centers for Medicare and Medicaid Services (CMS) announced that they would maintain the current classification of Auditory Osseointegrated Implants (AOIs) as prosthetic devices, and would not reclassify such devices as hearing aids, as originally proposed in July. This decision by CMS, released in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies final rule, comes as the result of coordinated advocacy efforts between the Academy and coalition of interested groups.

These advocacy efforts began in early July, when CMS set forth to make changes to several policies impacting audiology. Under the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies proposed rule, CMS proposed to reclassify AOIs such as the BAHA and Ponto, from prosthetic devices to hearing aids. If adopted, this would have meant that AOIs would no longer be covered under Medicare beginning on January 1, 2015. Such a reclassification would have eliminated coverage for individuals who would have otherwise used these devices to address their hearing loss, leaving them no affordable alternative and causing them to continue to live with serious hearing loss.

The Academy worked closely with its members, other audiology organizations, consumer groups, industry, and its congressional partners in the Friends of the Congressional Hearing Health Caucus to coordinate efforts to challenge the proposed AOI policy.  The Academy, in addition to these other groups, sent letters expressing our opposition to this proposed policy, and individuals met with CMS to request that CMS reconsider this reclassification. The Congressional Hearing Health Caucus, chaired by Representatives Carolyn McCarthy (D-NY) and Tom Latham (R-IA), also spoke out on behalf of the proposed change, urging CMS maintain the current benefit for AOIs.  CMS reportedly received over 2600 public comments in response to this provision. 

In the final rule, CMS explicitly states that cochlear devices, brainstem implants, and AOIs are invasive devices and are significantly different than the hearing devices in existence at the time the Medicare coverage exclusion for hearing aids was enacted. For this reason, CMS does not consider them to be the hearing aids. CMS goes on to state that air conduction and non-osseointegrated bone conduction hearing devices utilized today are considered to be hearing aids excluded from coverage under the Medicare program.s

The Academy will continue to monitor these policies and provide appropriate guidance to our members as more information emerges. Click here for the latest updates on reimbursement policies impacting audiologists.

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