CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Semi-implantable and fully implantable middle ear hearing aids

Policy defines coverage stance for semi-implantable and fully implantable middle ear hearing aids for Medicare Advantage and Commercial Products, including device re-insertion, describes clinical background, and lists non-covered / not medically necessary procedure codes.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicySemi-implantable and fully implantable middle ear hearing aids

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionBenefits may vary by group/contract; providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to determine coverage limitations and member responsibility.

POLICY UPDATE CHANGES

No material clinical or coverage changes identified for this policy.

2Coverage stances (Medicare Advantage, Commercial)

6Non-covered / Not medically necessary codes listed

Coverage Summary

Policy covers semi-implantable and fully implantable middle ear hearing aids as alternatives to external acoustic hearing aids for sensorineural, conductive, or mixed hearing loss. The payer scope includes Medicare Advantage and Commercial Products. Coverage stance: these devices and device re-insertion are not covered / not medically necessary (cosmetic) per the policy.

Medical-Necessity Criteria

Medicare Advantage Plans Coverage Determination

Covered when ALL of the following are met:

ALL of the following

Semi-implantable and fully implantable middle ear hearing aids are not covered as the evidence is insufficient to determine the effects of the technology on health outcomes.
Re-insertion of the device after removal is not covered.

Commercial Products Coverage Determination

ALL of the following

Semi-implantable and fully implantable middle ear hearing aids are considered not medically necessary as the evidence is insufficient to determine the effects of the technology on health outcomes.
Re-insertion of the device after removal is considered not medically necessary.

Not Covered / Experimental

Semi-implantable and fully implantable middle ear hearing aids are not covered for Medicare Advantage and are considered not medically necessary for Commercial Products because the evidence is insufficient to determine the effects of the technology on health outcomes. Re-insertion of the device after removal is also not covered / not medically necessary. Although some devices have FDA approval, the supporting studies are limited (small single-arm and observational designs with limited follow-up).

Device examples include the semi-implantable Vibrant Soundbridge and Maxum, and the fully implantable Esteem. Available evidence consists mainly of small single-arm interventional studies and observational series with limited follow-up.

Coding

Not covered / Not medically necessary codes (Medicare Advantage & Commercial)CPT|HCPCSNot Covered

0951T	Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor (New Code Effective 7/1/2025)
0952T	Totally implantable active middle ear hearing implant; revision or replacement, with mastoidectomy and replacement of sound processor (New Code Effective 7/1/2025)
0953T	Totally implantable active middle ear hearing implant; revision or replacement, without mastoidectomy and replacement of sound processor (New Code Effective 7/1/2025)
0954T	Totally implantable active middle ear hearing implant; replacement of sound processor only, with attachment to existing transducers (New Code Effective 7/1/2025)
S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear
V5095	Semi-implantable middle ear hearing prosthesis

Provider Actions

Documentation Required

Benefit verification required

Benefits may vary by group/contract; providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to determine coverage limitations and member responsibility.

Check member Benefit Booklet
Check member Evidence of Coverage
Check member Subscriber Agreement

Billing Rule

Do not bill covered codes as payable

The following procedure codes are listed in this policy as not covered (Medicare Advantage) or not medically necessary (Commercial) and should not be expected to be paid under Medicare Advantage Plans or Commercial Products per this policy.

0951T
0952T
0953T
0954T
S2230
V5095

Background

Semi-implantable and fully implantable middle ear hearing aids are alternatives to external acoustic hearing aids for patients who cannot use conventional aids due to anatomic fit, sound quality, personal preference, or external ear pathology. FDA-approved devices include the semi-implantable Vibrant Soundbridge and Maxum, and the fully implantable Esteem. The evidence base is limited to small single-arm and observational studies, often with less than five years median follow-up, which restricts conclusions about long-term safety and effectiveness.

Definitions

Normal hearingDetection of sound at or below 20 decibels (dB).

Degrees of hearing loss (PTA)Mild 20-40 dB; Moderate 40-60 dB; Severe 60-80 dB; Profound ≥80 dB.