By Kristiina Huckabay
This article is a part of the March/April 2019, Volume 31, Number 2, Audiology Today issue.
The American Academy of Audiology (the Academy) and others recently requested revisions for codes and code descriptors in the CROS/BiCROS family and Centers for Medicare and Medicaid Services approved many of the proposed changes. The groups requested the changes to reflect changes in CROS/BiCROS technology.
CROS—contralateral routing of signal—systems are traditionally fit when a patient has unaidable hearing loss in the poorer ear and normal hearing in the better ear, whereas BiCROS—bilateral microphones with contralateral routing of signal—hearing aids are fit when a patient has unaidable hearing loss in the poorer ear and aidable hearing loss in the better ear. Both types of systems aid the listener by transmitting signals coming from the side with poorer hearing to the side with better hearing to overcome the head shadow effect.
The experienced clinician may recall that traditional wireless CROS and BiCROS technology were dedicated device pairs where the signal was wirelessly transmitted from an offside microphone (i.e., transmitter) to either a receiver or a hearing aid/receiver worn on the better ear. If the patient had normal hearing in one ear and unaidable loss in the other ear, a CROS system was ordered that did not provide amplification to the good ear and the system only served to transmit signals from the unaidable side to the ear with normal hearing. If the patient had aidable hearing loss in the better ear and unaidable loss in the poorer ear, then a BiCROS system was ordered where a transmitter was placed on the poorer ear and a hearing aid/receiver (that could be adjusted to fit the configuration of hearing loss in the better ear, while also receiving a signal from the transmitter) was fit on the better ear.
Current contralateral routing technology can be programmed in a CROS or BiCROS configuration where the hardware is the same, but the programming determines the functionality (i.e., routing) of the signal between the two devices. In addition, current hearing aid technology allows the clinician to dispense a contralateral routing device to an existing CROS-compatible hearing aid when clinically applicable. These changes in technology necessitated new codes in the Healthcare Common Procedure Coding System (HCPCS) system to clarify that the programming is what differs, whereas, the actual hearing devices can be the same.
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