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    v1.0.30
    OpenPayerPolicy UpdatesDurable Medical Equipment (DME)HUSKY Health Hearing Devices Prior Auth | OpenPaye…
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    CurrentHUSKY HealthPolicy N/A

    Hearing Aids and Assistive Listening Devices for Children Enrolled in Birth-to-Three

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    Coverage and prior authorization for hearing aids, assistive listening devices, related accessories, and certain repairs for children enrolled in Connecticut's Birth-to-Three program.

    Policy Summary
    PayerHUSKY Health
    PolicyHearing Aids and Assistive Listening Devices for Children Enrolled in Birth-to-Three
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateNovember 1, 2026
    Last ReviewSep 21, 2026
    Next Review DateN/A
    Key ActionSubmit prior authorization with a signed prescription, recent medical-necessity evaluation, enrollment attestation, caregiver-training documentation, and acquisition-cost pricing or invoice.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    RequiredPrior authorization
    Birth-to-ThreeProgram

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    6 months
    Documentation age limit
    AAC + shippingBilling basis
    2Clinical criteria

    Covered Services and Eligibility Criteria

    Initial Hearing-Aid or Assistive-Listening-Device Coverage

    Hearing aids and assistive listening devices for children enrolled in the Birth-to-Three program are considered medically necessary when all of the following criteria are met. These guidelines are not exhaustive; coverage is determined by the DSS definition of Medical Necessity, which prevails if there is a conflict. Authorization is based on medical necessity at the time it is issued and is not a guarantee of payment; payment depends on active coverage, applicable benefits, and policies in effect at the time of service.

    ALL of the following

    • The diagnosis or diagnoses support a disability and the need for a hearing aid or assistive listening device.
    • An evaluation performed by a qualified professional, such as an audiologist or speech-language pathologist (SLP), supports the need for a hearing aid or assistive listening device, including that the selected device type is appropriate for the infant or toddler.

    Hearing-Aid Repair

    Repair of Hearing Aid, Not Otherwise Classified (HCPCS Code V5298) is typically covered when the applicable medical-necessity criteria are met.

    ONE of the following

    • ALL of the following

      • The repair is necessary for the normal and effective functioning of the hearing aid.
      • The applicable initial hearing-aid or assistive-listening-device medical-necessity criteria are met.
    • The repair does not meet the criteria above but is determined medically necessary based on an assessment of the infant or toddler and the infant's or toddler's unique clinical needs.

    EPSDT Special Provision

    Under the EPSDT special provision, medically necessary services, products, or procedures may be covered for Medicaid enrollees under 21 years of age, even when coverage is not otherwise described by these guidelines.

    ALL of the following

    • The enrollee is under 21 years of age.
    • The service, product, or procedure is medically necessary health care to correct or ameliorate a defect, physical or mental illness, or a condition identified through a screening examination.
    • The applicable definition of medical necessity is met under Conn. Gen. Stat. Section 17b-259b (2011), as referenced in CMAP Provider Bulletin PB 2011-36.

    Medical-Necessity Requirements

    Device Medical Necessity

    The requested device must be supported by the child's diagnosis, functional need, and a qualified-professional evaluation.

    Device medical necessity

    • Diagnosis and disability support: The diagnosis or diagnoses support a disability and the need for the requested hearing aid or assistive listening device.
    • Qualified-professional evaluation: A qualified-professional evaluation supports the need for the device and the appropriateness of the selected device type for the infant or toddler.

      Qualified professionals may include an audiologist or speech-language pathologist.

    Covered Billing Codes

    Covered hearing aids and assistive listening devicesHCPCSCovered
    V5281Assistive listening device, personal FM/DM system, monaural, (1 receiver, transmitter, microphone), any type.
    V5282Assistive listening device, personal FM/DM system, binaural, (2 receivers, transmitter, microphone), any type.
    V5284Assistive listening device, personal FM/DM, ear level receiver.
    V5285Assistive listening device, personal FM/DM, direct audio input receiver.
    V5289Assistive listening device, personal FM/DM adapter/boot coupling device for receiver, any type.
    V5290Assistive listening device, transmitter microphone, any type.
    V5298Hearing aid, not otherwise classified
    Prior-authorized hearing-aid repairHCPCSCovered
    V2598Repair of hearing aid, not otherwise classified.
    External sound processor subject to InterQual reviewHCPCSCovered
    L8692Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.

    Authorization, Documentation, and Billing Actions

    Prior Authorization

    Prior Authorization Required for Listed Devices and Repairs

    Prior authorization is required before delivery for the listed monaural and binaural assistive listening devices, receivers, transmitters, accessories, hearing aids, repairs, and related services.

    • Monaural assistive listening device — HCPCS V5281
    • Binaural assistive listening device — HCPCS V5284
    • Receivers, transmitters, and accessories — HCPCS V5284, V5285, V5289, V5290
    • Hearing aid, not otherwise classified — HCPCS V5298
    • Repair of hearing aid, not otherwise classified — HCPCS V2598
    Documentation Required

    InterQual Review for External Sound Processor

    HUSKY Health uses InterQual criteria when reviewing prior authorization requests for an auditory osseointegrated device external sound processor used without osseointegration, body worn, including a headband or other external attachment.

    Prior-Authorization Submission Requirements

    Documentation Required

    Submit complete clinical and cost documentation

    Submit a complete prior-authorization request with enrollment attestation, a recent signed prescription, diagnosis, item description and quantity, a recent medical-necessity evaluation, caregiver education and demonstrated proper use, and actual acquisition-cost pricing or invoice documentation.

    • Enrollment attestation from the treating physician, audiologist, APRN, or PA.
    • Signed prescription written within the past 6 months by a treating physician, audiologist, APRN, or PA enrolled in CMAP.
    • Evaluation documentation dated within the past 6 months addressing medical necessity.
    • Documentation that the caregiver received education and demonstrated proper use.
    • Pricing information or an invoice showing AAC for each listed code requiring prior authorization.

    Policy Scope

    This policy addresses hearing aids and assistive listening devices for infants and toddlers enrolled in Connecticut’s Birth-to-Three program. Coverage is evaluated according to the child’s individual medical condition and unique clinical needs, including whether the diagnosis supports a disability and need for the device and whether a qualified professional’s evaluation supports the need and appropriateness of the selected device type.

    Key Policy Definitions

    Medical necessity
    DefinitionHealth services required to prevent, identify, diagnose, treat, rehabilitate, or ameliorate an individual's medical condition or its effects in order to attain or maintain achievable health and independent functioning.
    Clinical standardConsistent with generally accepted standards of medical practice and clinically appropriate and effective for the individual's illness, injury, or disease.
    Cost and convenienceNot primarily for convenience and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results.
    Individual assessmentBased on an assessment of the individual and the individual's medical condition.
    Prior authorization
    Definition
    Policy Summary
    PayerHUSKY Health
    PolicyHearing Aids and Assistive Listening Devices for Children Enrolled in Birth-to-Three
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateNovember 1, 2026
    Last ReviewSep 21, 2026
    Next Review DateN/A
    Key ActionSubmit prior authorization with a signed prescription, recent medical-necessity evaluation, enrollment attestation, caregiver-training documentation, and acquisition-cost pricing or invoice.
    SourceLink
    On This Page
    Covered Services and Eligibility CriteriaMedical-Necessity RequirementsCovered Billing CodesAuthorization, Documentation, and Billing ActionsPrior-Authorization Submission RequirementsPolicy ScopeKey Policy Definitions
    • HCPCS L8692
    Documentation Required

    Submit a Completed Authorization Request

    Submit a fully completed authorization request through the online web portal or a fully completed Outpatient Prior Authorization Request Form for the requested hearing aid, assistive listening device, item, repair, or related service.

    Documentation Required

    Verify Birth-to-Three Enrollment

    Include current documentation from the treating physician, audiologist, APRN, or PA attesting that the child is enrolled in the Birth-to-Three program.

    • The attestation must be from an authorized treating professional.
    Documentation Required

    Include a Current Signed Prescription

    Include a signed prescription written within the past 6 months by a treating physician, audiologist, APRN, or PA enrolled in the Connecticut Medical Assistance Program (CMAP).

    • Include the diagnosis or diagnoses.
    • Describe the hearing aid, assistive listening device, and/or item.
    • State the quantity ordered.
    Documentation Required

    Document Recent Medical Necessity

    Include evaluation documentation dated within the past 6 months from the treating provider, such as an audiologist or speech-language pathologist, addressing medical necessity for the requested device or item.

    • The evaluation should support that the diagnosis or diagnoses represent a disability and the need for the device.
    • The evaluation should support that the selected device type is appropriate for the infant or toddler.
    Documentation Required

    Document Caregiver Training and Competency

    Document that the caregiver or caregivers received education on use of the hearing aid or assistive listening device and demonstrated proper use.

    • Submit documentation of both caregiver training and demonstrated competency.
    Billing Rule

    Provide Actual Acquisition Cost Documentation

    Submit pricing information or an invoice showing the actual acquisition cost (AAC) for each applicable code requiring prior authorization.

    • The documentation must identify the AAC for the requested device, accessory, repair, or related item.
    Denial Risk

    Resolve Medical-Necessity or Documentation Deficiencies

    Requests may not be approved when the submitted information does not establish medical necessity or is incomplete. Address diagnosis, qualified-professional evaluation, device appropriateness, and all required supporting documentation before submission.

    • Diagnosis must support a disability and the need for a hearing aid or assistive listening device.
    • Evaluation must support medical necessity and that the selected device is appropriate for the child.
    • Missing enrollment verification, prescription, recent evaluation, caregiver competency documentation, or AAC information may result in non-approval.
    Prior Authorization

    Do Not Deliver Without Required Authorization

    Prior authorization for hearing aids and assistive listening devices for children enrolled in Birth-to-Three is required, and listed devices, accessories, repairs, and related services must be authorized before delivery.

    • Requests are reviewed under procedures for durable medical equipment using requested and/or submitted case-specific information.
    • Authorization based on medical necessity at issuance is not a guarantee of payment; active coverage, benefits, and policies must apply at the time of service.
    Billing Rule

    Bill at Actual Acquisition Cost Plus Shipping

    Codes requiring prior authorization must be billed at actual acquisition cost plus shipping, supported by pricing information or an invoice documenting the AAC.

    • Unsupported acquisition-cost billing may result in payment issues or non-approval.
    • Apply the AAC-plus-shipping rule to all applicable prior-authorized codes listed in this policy.
    A process for approving covered services before delivery of the service or initiation of the plan of care based on a determination by CHNCT as to whether the requested service is medically necessary.
    TimingApproval is required prior to delivery of the service or initiation of the plan of care.
    Basis for approvalThe requested service must be determined to be medically necessary.