Semi-implantable and fully implantable middle ear hearing aids
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This policy governs the medical policy and coverage stance for semi-implantable and fully implantable middle ear hearing aids for Capital Bluecross members and applies to products/programs administered by Capital Blue Cross with possible benefit variations.
Policy went from medically necessary (MN) to investigational (INV).
Coverage Determinations
Investigational / Not Covered
Covered when ALL of the following are met:
Insufficient evidence to conclude a net health benefit compared with external acoustic hearing aids; safety data are limited with median follow-up less than 5 years, and study sizes are small.
Investigational / Not Covered — current coverage stance
Current coverage stance:
Policy history documents a change from medically necessary to investigational on 8/26/2025; listed procedure codes are designated investigational and would be denied if billed.
The following procedure code is designated Investigational and is therefore not covered under this policy: 0955T.
Procedures and services associated with codes listed as investigational in this policy are excluded from coverage. Billing or authorization of these investigational procedure codes does not imply coverage will be provided.
The evidence base includes single-arm interventional studies submitted to the FDA, systematic reviews, and observational series. Although some studies suggest semi- and fully implantable middle ear hearing aids may improve hearing relative to conventional external acoustic hearing aids in select patients, the available trials enroll limited numbers of patients and have a median follow-up of <5 years. Given the established safety and effectiveness of external acoustic hearing aids and the added risks of surgery, the current evidence is insufficient to determine that the technology results in an improvement in net health outcome.
Because the procedures and devices discussed in this policy have been determined to be investigational based on limited and inconclusive evidence, they are considered not medically necessary under this policy and are not covered.
Procedure and Product Codes
| 0955T | Listed in document as investigational procedure code (repeated multiple times) |
| FDA product code MPV | Product code for semi-implantable devices (Vibrant Soundbridge, Maxum) |
| FDA product code OAF | Product code for fully implantable Esteem device |
| 0955T | Listed procedure code(s) identified in document as investigational / not covered |
Provider Responsibilities and Billing Notes
Prior authorization and benefit verification
Verify member benefits and prior authorization requirements before scheduling or billing for semi-implantable or fully implantable middle ear hearing aids, because these devices/procedures are designated investigational and not covered under this policy; coverage is subject to member benefit terms and eligibility.
- These procedures are investigational and not covered; verify member-specific benefits and prior authorization rules before providing services.
- Product/program variations may apply; see benefit plan details (some programs may have different policies).
Prior authorization — investigational codes (0955T)
Do not expect prior authorization to make investigational procedures payable: procedures billed with code 0955T are categorized as investigational and not covered, and prior authorization would not render them payable under this policy.
- Code 0955T is listed repeatedly in the investigational (not covered) procedure code list.
- Prior authorization cannot override the policy designation of investigational/not covered.
Treatment alternatives — external and bone‑conduction devices
Offer and document standard treatment alternatives such as external acoustic hearing aids or implantable bone-conduction/bone-anchored devices when applicable; these are established alternatives to semi- or fully implantable middle ear devices.
- External acoustic hearing aids are the typical treatment for moderate-to-severe sensorineural hearing loss.
- Consider bone-conduction or bone-anchored hearing aids for conductive losses or when external devices cannot be used.
Provider action — verify program applicability and benefits
Providers should follow all normal preauthorization, coding, and documentation workflows and confirm member eligibility and benefit variations for the specific product or program before proceeding.
- This policy applies only to certain programs and products administered by Capital Blue Cross; program-specific variations and FEP policies may differ.
- Coding identification in the policy does not denote coverage; verify coverage under the member's benefit plan.
Coding and documentation note — code listing ≠ coverage
Include the appropriate procedure code(s) on claims, but note that the listing of codes in the policy does not denote coverage; claims remain subject to member benefit terms and medical necessity determinations.
- The coding list may not be all‑inclusive and is subject to change.
- Identification of a code in the policy does not imply coverage or separate reimbursement eligibility.
Documentation note — indicate investigational status on billing
When submitting claims, reflect that the listed procedure codes (for example, 0955T) are designated investigational and not covered per policy; billing should align with the policy's investigational designation.
- 0955T is listed in the policy's investigational (not covered) procedure code list.
- Policy history documents the investigational designation effective after the 8/26/2025 major review.
Investigational — Not covered (do not bill for investigational procedures)
Do not bill for devices or procedures identified as investigational (e.g., semi‑implantable and fully implantable middle ear hearing aids and procedure code 0955T); these devices/procedures are considered investigational and therefore not covered, with clinical and billing implications for payment denial.
- Semi‑implantable and fully implantable middle ear hearing aids are considered investigational and not covered.
- Claims for listed investigational procedure codes (including 0955T) may be denied as investigational.
Investigational procedures — claim denial risk
Billing for investigational procedure codes such as 0955T will result in claim denial because the procedures are designated investigational and not covered under this policy.
- 0955T is explicitly listed in the policy's investigational (not covered) procedure code list and will be denied if billed.
- Prior authorization will not make these investigational procedure codes payable.
Clinical Background
Hearing loss may be classified as conductive, sensorineural, or mixed and severity is commonly described using pure-tone averages. External acoustic hearing aids are the standard treatment for many patients. Semi-implantable devices (for example, the Vibrant Soundbridge and Maxum) typically use electromagnetic transduction, while fully implantable devices (for example, Esteem) use piezoelectric transduction and may require disruption of the ossicular chain. Implantable middle ear devices are alternative options for patients who cannot use external devices or who seek different sound quality, but evidence is limited regarding long-term effectiveness and comparative outcomes.
Key Terms and Examples
Policy Revision Timeline
Consensus review performed; policy statement unchanged.
Major review resulting in change of policy status from medically necessary (MN) to investigational (INV); rationale updated.
Major review that resulted in policy designated as medically necessary (MN) with criteria; FEP, background, rationale, coding table, and references updated.
Policy effective date shown in header.
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