Semi-Implantable and Fully Implantable Middle Ear Hearing Aid
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This policy governs BCBSNC coverage of semi-implantable and fully implantable middle ear hearing aids for members and outlines clinical background, regulatory status, and coverage determination for providers and adjudicators.
No material clinical or coverage changes in this revision.
Coverage Determination
Overall coverage stance
Coverage determination
BCBSNC does not provide coverage for investigational services or procedures.
Semi-implantable and fully implantable middle ear hearing aids are considered investigational for all indications and are excluded from coverage. BCBSNC does not provide coverage for investigational services or procedures.
Applicable Service and Billing Codes
| 0951T | Listed applicable service code |
| 0952T | Listed applicable service code |
| 0953T | Listed applicable service code |
| 0954T | Listed applicable service code |
| 0955T | Listed applicable service code |
| 69799 | Unlisted procedure, established elsewhere in document |
| S2230 | Hearing device, prosthesis (listed as applicable service code) |
| V5095 | Hearing device supply (listed as applicable service code) |
| No codes listed |
Provider Requirements and Billing Notes
Prior authorization / applicable codes — inclusion does not guarantee reimbursement
Applicable service codes are listed in the policy; inclusion of a code does not guarantee reimbursement and BCBSNC may request medical records to determine medical necessity.
Action required — confirm coverage before scheduling
Semi-implantable and fully implantable middle ear hearing aids are considered investigational for all indications; do not assume coverage and verify benefit eligibility before proceeding.
- BCBSNC does not provide coverage for investigational services or procedures
- Confirm member benefits and prior authorization requirements because investigational status may result in noncoverage
Medical records and documentation — supply complete records when requested
BCBSNC may request medical records to determine medical necessity; when records are requested, include complete documentation, and consider submitting letters of support or explanation that contain all specific information needed for the determination.
- Provide complete medical records when requested
- Letters of support/explanation are often useful but are not sufficient unless they include all required information to establish medical necessity
Denial risk — investigational device may lead to claim denials
Claims for implantation of these devices may be denied because the devices are considered investigational and excluded from coverage.
- Do not assume reimbursement for device implantation; investigational designation is a denial risk
- Verify eligibility and consult policy before performing implantation procedures
Clinical Background
Hearing loss may be conductive, sensorineural, or mixed and is commonly classified by pure-tone average thresholds. External acoustic hearing aids are the standard management for many patients, but implantable middle ear devices have been developed as alternatives for individuals who cannot use or do not tolerate external devices.
A semi-implantable middle ear hearing aid typically incorporates an implanted magnetic component attached to the ossicles, a receiver, and an externally worn sound processor (examples include the Vibrant Soundbridge and Maxum); these systems transduce electrical signals into electromagnetic energy to directly vibrate the middle ear ossicles.
A fully implantable middle ear hearing aid is a completely implanted system (example: Envoy Esteem) that uses implanted sensors, drivers, and a sound processor—often employing piezoelectric components—to detect and drive ossicular vibrations without an external processor.
Although these devices aim to improve sound transmission by stimulating the ossicular chain, BCBSNC’s policy position is that both semi-implantable and fully implantable middle ear hearing aids remain investigational and are not covered.
Device Definitions
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