Aetna considers automated audiometry that is either self-administered or administrated by non-audiologists experimental and investigational because its effectiveness has not been adequately validated to be equivalent to audiometry performed by an audiologist.
A limited number of studies have compared computer-assisted audiometry that is self-administered or administered by non-audiologists to audiometry administered by an audiologist.
Mahomed et al (2013) conducted a meta-analysis of studies reporting within-subject comparisons of manual and automated threshold audiometry. The authors found overall average differences between manual and automated air conduction audiometry to be comparable with test-retest differences for manual and automated audiometry. The authors found, however, limited data on automated audiometry in children and difficult-to-test populations, automated bone conduction audiometry, and data on the performance of automated audiometry in different types and degrees of hearing loss.
The American Speeh-Language Hearing Association (2013) recommends that hearing screening be conducted under the supervision of an audiologist holding the ASHA Certificate of Clinical Competence (CCC).
In a prospective diagnostic study, Foulad et al (2103) determined the feasibility of an Apple iOS-based automated hearing testing application and compared its accuracy with conventional audiometry. An iOS-based software application was developed to perform automated pure-tone hearing testing on the iPhone, iPod touch, and iPad. To assess for device variations and compatibility, preliminary work was performed to compare the standardized sound output (dB) of various Apple device and headset combinations. A total of 42 subjects underwent automated iOS-based hearing testing in a sound booth, automated iOS-based hearing testing in a quiet room, and conventional manual audiometry. The maximum difference in sound intensity between various Apple device and headset combinations was 4 dB. On average, 96 % (95 % confidence interval [CI]: 91 % to 100 %) of the threshold values obtained using the automated test in a sound booth were within 10 dB of the corresponding threshold values obtained using conventional audiometry. When the automated test was performed in a quiet room, 94 % (95 % CI: 87 % to 100 %) of the threshold values were within 10 dB of the threshold values obtained using conventional audiometry. Under standardized testing conditions, 90 % of the subjects preferred iOS-based audiometry as opposed to conventional audiometry. The authors concluded that Apple iOS-based devices provided a platform for automated air conduction audiometry without requiring extra equipment and yielded hearing test results that approach those of conventional audiometry. This was a feasibility study; its findings need to be validated by well-designed studies.
CPT codes not covered for indications listed in the CPB:
Pure tone audiometry (threshold), automated; air only [without an audiologist]
air and bone [without an audiologist]
The above policy is based on the following references:
Mahomed F, Swanepoel DW, Eikelboom RH, Soer M. Validity of automated threshold audiometry: A systematic review and meta-analysis. Ear Hear. 2013;34(6):745-752.
Yu J, Ostevik A, Hodgetts B, Ho A. Automated hearing tests: Applying the otogram to patients who are difficult to test. J Otolaryngol Head Neck Surg. 2011;40(5):376-383.
Swanepoel de W, Mngemane S, Molemong S, et al. Hearing assessment-reliability, accuracy, and efficiency of automated audiometry. Telemed J E Health. 2010;16(5):557-563.
Margolis RH, Glasberg BR, Creeke S, Moore BC. AMTAS: Automated method for testing auditory sensitivity: Validation studies. Int J Audiol. 2010;49(3):185-194.
Ho AT, Hildreth AJ, Lindsey L. Computer-assisted audiometry versus manual audiometry. Otol Neurotol. 2009;30(7):876-883.
American Speech-Language-Hearing Association (ASHA). Hearing screening and testing. Information for the Public. Rockville, MD: ASHA; 2013.
Foulad A, Bui P, Djalilian H. Automated audiometry using apple iOS-based application technology. Otolaryngol Head Neck Surg. 2013;149(5):700-706.
Khoza-Shangase K, Kassner L. Automated screening audiometry in the digital age: Exploring Uhear™ and its use in a resource-stricken developing country. Int J Technol Assess Health Care. 2013;29(1):42-47.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.