CurrentUnitedHealthcarePolicy 2025T0396GG

Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable

UnitedHealthcare medical policy governing coverage and medical necessity criteria for wearable air-conduction hearing aids, non-implantable bone conduction devices (headband/adhesive), semi-implantable electromagnetic devices, and implantable bone-anchored hearing aids for UnitedHealthcare Commercial and Individual Exchange plans (with some state exceptions). Also lists applicable CPT/HCPCS/Codes, definitions, benefit considerations, and evidence summaries.

Policy Summary

PayerUnitedHealthcare

PolicyHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable

Policy CodePolicy 2025T0396GG

Change TypeCoding updates; reference link update; archived prior version

Effective DateJul 1, 2025

Next Review Date

Key ActionVerify member-specific benefit plan and document required medical records (preoperative audiometry, word recognition, age, prior hearing aid experience, symmetry criteria) to determine whether the member meets device-specific coverage criteria.

POLICY UPDATE CHANGES

Updated reference link to the Medicare Advantage Medical Policy titled Hearing Aids and Auditory Implants.

Added CPT codes 0951T, 0952T, 0953T, 0954T, and 0955T to applicable codes list.

Archived previous policy version 2025T0396FF.

6Proven/Covered Device Categories Listed

3Unproven/Not Medically Necessary Device Types Listed

100+Procedure/HCPCS codes listed

Major complication rate (pTCBI)

13.1%Minor complication rate (pTCBI)

5New CPT codes added

Coverage Summary

Scope: This UnitedHealthcare medical policy (Policy No. 2025T0396GG; effective July 1, 2025) governs coverage and medical necessity criteria for wearable air‑conduction hearing aids, non‑implantable bone conduction devices (headband/adhesive), semi‑implantable electromagnetic devices, and implantable bone‑anchored hearing aids for UnitedHealthcare Commercial and Individual Exchange plans (with some state exceptions).

Covered device categories (Proven/Medically Necessary per policy): wearable air‑conduction Hearing Aids; bilateral or unilateral non‑implantable bone conduction Hearing Aids using a headband or adhesive (non‑osseointegrated) for individuals not candidates for air‑conduction devices; semi‑implantable electromagnetic hearing aids for sensorineural hearing loss; bilateral or unilateral fully or partially implantable bone‑anchored Hearing Aids for conductive or mixed hearing loss (including some indications for single‑sided deafness).

Not covered (Unproven / Not Medically Necessary per policy): intraoral bone conduction Hearing Aids, laser or light‑based Hearing Aids, and totally implanted middle ear hearing systems (insufficient evidence of efficacy).

Quick-reference thresholds & key dates

Bone-conduction threshold for candidacy<= 25 dB HL (PTA BC at 0.5,1,2,3 kHz)

Air-conduction threshold defining normal hearing<= 20 dB HL (PTA AC at 0.5,1,2,3 kHz)

New CPT codes added0951T, 0952T, 0953T, 0954T, 0955T (added to policy effective 07/01/2025)

Policy effective dateJuly 1, 2025

Medical-Necessity Criteria

Proven and Medically Necessary

Covered when the device is required for correction of a hearing impairment and the member meets plan/medical necessity criteria:

ANY of the following

Wearable air-conduction hearing aids: Wearable air-conduction Hearing Aids required for the correction of a Hearing Impairment
Headband/adhesive bone-conduction (non-implantable): Bilateral or unilateral bone conduction Hearing Aids utilizing a headband or adhesive (without osseointegration) for individuals not candidates for air-conduction hearing aid
Fully or partially implantable bone-anchored (bilateral): Bilateral fully or partially implantable bone-anchored Hearing Aids for Conductive or Mixed Hearing Loss in both ears

Coding

Bone Anchored Hearing Aids (BAHA) CPTCPTCovered

69710	Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone.
69714	Implantation, osseointegrated implant; skull; with percutaneous attachment to external speech processor.
69716	Implantation, osseointegrated implant; skull; with magnetic transcutaneous attachment to external speech processor; within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex.
69717	Replacement (including removal of existing device), osseointegrated implant; skull; with percutaneous attachment to external speech processor.
69719	Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex.
69729	Implantation, osseointegrated implant; skull; with magnetic transcutaneous attachment to external speech processor; outside of the mastoid and resulting in removal of >= 100 sq mm surface area of bone deep to the outer cranial cortex.
69730	Replacement (including removal of existing device), osseointegrated implant; skull; with magnetic transcutaneous attachment to external speech processor; outside the mastoid and involving a bony defect >= 100 sq mm surface area of bone deep to the outer cranial cortex.

Fitting and Testing CPTCPTCovered

92590	Hearing aid examination and selection; monaural.
92591	Hearing aid examination and selection; binaural.
92592	Hearing aid check; monaural.
92593	Hearing aid check; binaural.
92594	Electroacoustic evaluation for hearing aid; monaural.
92595	Electroacoustic evaluation for hearing aid; binaural.

Semi-Implantable / Totally Implantable CPT and UnlistedCPTCovered

69799	Unlisted procedure, middle ear.
0951T	Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor.
0952T	Totally implantable active middle ear hearing implant; revision or replacement; with mastoidectomy and replacement of sound processor.
0953T	Totally implantable active middle ear hearing implant; revision or replacement; without mastoidectomy and replacement of sound processor.
0954T	Totally implantable active middle ear hearing implant; replacement of sound processor only, with attachment to existing transducers.
0955T	Totally implantable active middle ear hearing implant; removal, including removal of sound processor and all implant components.

HCPCS / L-codes (Implantable devices, external processors)HCPCSCovered

L8690	Auditory osseointegrated device, includes all internal and external components.
L8691	Auditory osseointegrated device, external sound processor; excludes transducer/actuator; replacement only, each.
L8693	Auditory osseointegrated device abutment; any length, replacement only.
L8694	Auditory osseointegrated device, transducer/actuator; replacement only, each.
L8692	Auditory osseointegrated device, external sound processor; used without osseointegration, body worn, includes headband or other means of external attachment.

HCPCS / V-codes for Wearable and FittingHCPCSCovered

S0618	Audiometry for hearing aid evaluation to determine the level and degree of hearing loss.
V5010	Assessment for hearing aid.
V5011	Fitting/orientation/checking of hearing aid.
V5014	Repair/modification of a hearing aid.
V5020	Conformity Evaluation.
V5264	Ear mold/insert; not disposable, any type.
V5265	Ear mold/insert; disposable, any type.
V5275	Ear impression, each.
V5095	Semi-implantable middle ear hearing prosthesis.
V5030	Hearing aid, monaural, body worn, air conduction.

1–10 of 54

1/6

Regulatory / device clearances (informational, not billing codes)mixed

K183373	Bonebridge 510(k) marketing clearance (March 2019)
K190589	Osia System 510(k) clearance
K191921	Osia 2 System 510(k) clearance
K211640	Ponto 5 Mini 510(k) clearance
K110831	SoundBite FDA clearance (2011) - manufacturing ceased

Applicable CPT Codes (updated list)CPT

0951T
0952T
0953T
0954T
0955T

Provider Actions & Billing Rules

Documentation Required

Medical records required for review

Medical records documentation may be required to assess whether the member meets clinical criteria for coverage. Benefits and final coverage determinations are governed by the member‑specific benefit plan document and applicable laws.

Documentation Required

Equipment upgrade treatment

Equipment upgrades are treated as new services. A change in the member's medical condition or equipment needs requires the same clinical criteria and documentation as a new request.

Background & Evidence

Background — device definitions: Air‑conduction Hearing Aids (ACHA) are electronic sound‑amplifying devices that pick up sound with a microphone, amplify it, and deliver it into the ear canal via a receiver. Semi‑implantable electromagnetic Hearing Aids (SEHA) use an implanted magnetic component in the middle ear driven by an external sound processor to vibrate the ossicular chain and are classified by the FDA as hearing aids. Bone‑anchored (bone conduction) Hearing Aids include non‑implantable transcutaneous devices held by headband or adhesive, percutaneous fully implantable systems with osseointegrated abutments, and partially implantable transcutaneous systems using subdermal magnetic coupling; these are also classified by the FDA as hearing aids.

Clinical hearing loss definitions: Conductive Hearing Loss occurs when sound is not conducted efficiently through the outer or middle ear and is often correctable medically or surgically. Sensorineural Hearing Loss (SNHL) results from damage to the inner ear (cochlea) or auditory nerve and is usually not medically or surgically correctable. Mixed Hearing Loss is a combination of conductive and sensorineural components.

Regulatory and classification note: Many semi‑implantable electromagnetic and bone‑anchored devices are FDA‑classified and cleared as Hearing Aids or bone‑conduction hearing systems (examples include Vibrant Soundbridge, Maxum, BAHA/Baha systems, Bonebridge, Osia systems, and Earlens), and device‑specific labeling specifies candidacy criteria, age limits, and audiometric thresholds used to determine appropriate use.

Citation/Source	Key Finding
Cochrane (Ferguson et al., 2017)
RCTs indicate hearing aids improve hearing-specific and general quality of life for mild to moderate adult hearing loss.
Multiple systematic reviews and cohort studies (BAHA, VSB, Bonebridge, pTCBI)
Generally show audiologic benefit, improved speech discrimination in noise, and high patient satisfaction though evidence quality variable and often limited to observational studies.
Cooper and McDonald (2017) pTCBI systematic review
482 devices reported; major complications 5.2%; minor complications 13.1%; weighted mean PTA 28.4 ±2.1 dB; mean SRT 32.9 ±3.9 dB.
Gurgel et al. (2015) SoundBite prospective case series
81 patients with SSD; significant benefit on APHAB and SSD questionnaires; no serious adverse events though 9 withdrew due to device problems.
Gantz et al. (2017) Earlens trial
43 subjects (86 ears); no change in residual hearing at 120 days; significant improvements in word recognition; supported FDA clearance.
Peixoto et al. (2023) Carina retrospective
15 participants (16 ears); functional gain 15-20 dB at 1 year; greater improvements in mixed hearing loss vs SNHL; feedback issues required adjustments.
Shohet et al. (2018) Esteem 5-year post-market
51 subjects implanted; improvements in SRT and WRS; 3 SADEs and 15 ADEs; average battery life 4.9 years.

Definitions (policy)

Conductive Hearing LossSound not conducted efficiently through outer/middle ear; often correctable medically or surgically.

Other Device Types — Informational Status

Other Device Types - Informational/Status

Descriptions and regulatory status; informational only (no coverage criteria):

Esteem (informational): Totally implanted middle ear hearing system (Esteem) — FDA approved (informational reference)

Informational; not a coverage rule

SoundBite (informational): Intraoral bone conduction hearing aid (SoundBite) — FDA cleared 2011; manufacturing ceased in 2015 (informational)

Informational; device unavailable

Earlens (informational): Laser or light-based contact hearing aid (Earlens) — FDA cleared April 2016 for adults 18+ with mild to severe sensorineural hearing impairment (informational)

Informational

Revision History

07/01/2025code_update

Material change: Added CPT codes 0951T, 0952T, 0953T, 0954T, and 0955T to the applicable codes list (quarterly CPT edits).

08/01/2025reference_updateLatest

Non-material change: Updated reference link to the Medicare Advantage Medical Policy titled Hearing Aids and Auditory Implants.

archived_version

Non-material: Archived previous policy version 2025T0396FF.

Policy Summary

PayerUnitedHealthcare

PolicyHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable

Policy CodePolicy 2025T0396GG

Change TypeCoding updates; reference link update; archived prior version

Effective DateJul 1, 2025

Next Review Date

On This Page

Semi-implantable electromagnetic (SEHA): Semi-implantable electromagnetic hearing aid for Sensorineural Hearing Loss

Fully or partially implantable bone-anchored (unilateral): Unilateral fully or partially implantable bone-anchored Hearing Aids for conductive or Mixed Hearing Loss in one or both ears

Fully or partially implantable bone-anchored for SNHL (unilateral): Unilateral fully or partially implantable bone-anchored Hearing Aids for Sensorineural Hearing Loss in one ear

Non-Implantable Bone-Conduction Hearing Aids - Coverage Criteria

Covered when ALL of the following are met:

ALL of the following

Indication is unilateral or bilateral conductive hearing loss, either chronic or temporary, or single-sided deafness (unilateral profound sensorineural deafness) with normal hearing in the contralateral ear
BC PTA threshold: Pure tone average bone-conduction hearing threshold (measured at 0.5, 1, 2, and 3 kHz) is better than or equal to 25 dB HL<= 25 dB HL
Contralateral normal hearing: Normal hearing in contralateral ear defined as pure tone average air-conduction hearing threshold (measured at 0.5, 1, 2, and 3 kHz) better than or equal to 20 dB HL<= 20 dB HL

ADHEAR System (non-implantable bone conduction)

Covered when ALL of the following are met:

ALL of the following

Indication for use: Use for individuals with conductive hearing loss or single-sided deafness via bone conduction
Non-invasive retention: Device is non-invasive and retained with an elastic headband or adhesive adapter placed behind the auricle

Device-specific FDA selection/indication criteria (summarized per device)

Device labeling selection criteria and indications as stated by FDA or manufacturer (summarized per device):

Vibrant Soundbridge selection criteria: audiologic results consistent with moderate to severe sensorineural hearing loss; adults 18+; pure tone AC thresholds within device-specified ranges at 500-4000 Hz; word recognition score >=50% using recorded material; normal middle ear anatomy; psychologically suitable

From FDA labeling

Maxum Hearing Implant selection criteria: audiologic results consistent with moderate to severe sensorineural hearing loss; adults 18+; patients desiring an alternative to acoustic hearing device; prior experience with appropriately fit hearing aids recommended

From FDA labeling

BAHA / Bone-anchored general: BAHA indications: adults with external ear malformations or chronically draining ear, PTA hearing loss >=45 dB or inability/unwillingness to use air conduction hearing aid; children 5+ (clearance extension)PTA BC >=45 dB HL (per labeling)

From FDA clearance

BAHA bilateral implantation: Bilateral implantation criteria: moderate to severe bilateral symmetrical conductive hearing loss ( <10 dB average difference or <15 dB at individual frequencies at 500,1,2,4 kHz) or mixed loss with average BC thresholds better than 45 dB HL

From FDA labeling

BAHA for SSD: SSD indication: unilateral SNHL with normal hearing in contralateral ear; normal hearing defined as PTA AC <=20 dB at 0.5,1,2,3 kHz; alternative to AC CROS<= 20 dB HL (AC) contralateral

From FDA labeling

Otomag Alpha 1 / Sophono: conductive or mixed losses with PTA BC for indicated ear better than 45 dB HL; bilateral symmetry criteria (<10 dB average difference or <15 dB at individual frequencies); SSD PTA AC of hearing ear <=20 dB HL<= 45 dB HL (BC) for indicated ear; <=20 dB HL (AC) for normal hearing

From FDA labeling

Cochlear Baha Attract: PTA BC <=45 dB HL for BP100 processor; <=55 dB HL for BP1100 processor (0.5,1,2,3 kHz); patients aged 5+; bilateral when criteria met; SSD defined as PTA AC <=20 dB HL<=45 dB HL (BP100); <=55 dB HL (BP1100); <=20 dB HL (AC) contralateral

From FDA labeling

Bonebridge (MED-EL): Bonebridge indications: PTA BC <=45 dB HL (0.5,1,2,3 kHz); patients 12+; bilateral symmetric definitions (<10 dB average or <15 dB individual); SSD alternative to AC CROS with hearing ear PTA AC <=20 dB HL; recommended prior experience with fitted hearing aids<=45 dB HL (BC); <=20 dB HL (AC) for SSD

From FDA labeling and ECRI assessment

Osia / Osia 2 (Cochlear): Osia and Osia 2 indications: PTA BC <=55 dB HL (0.5,1,2,3 kHz); patients 12+; bilateral fit for symmetric losses (<10 dB average or <15 dB at individual frequencies); SSD: profound SNHL in one ear with normal hearing in opposite ear (AC PTA <=20 dB HL); prior experience with fitted hearing aids recommended<=55 dB HL (BC); <=20 dB HL (AC) for SSD

From FDA labeling

ADHEAR System: intended for all ages with unilateral or bilateral conductive hearing loss or SSD; PTA BC <=25 dB HL (0.5,1,2,3 kHz); retained with elastic headband or adhesive adapter behind auricle<=25 dB HL (BC)

From FDA labeling

Earlens (light-driven): Earlens Contact Hearing Aid: adults 18+ with mild to severe sensorineural hearing impairment; provides amplification 125 Hz to 10,000 Hz

From FDA labeling

SoundBite (intraoral): SoundBite intraoral bone conduction system: FDA cleared 2011; manufacturing ceased 2015 (informational)

From FDA clearance information

Unproven / Not Medically Necessary

Not covered due to insufficient evidence of efficacy:

ALL of the following

Intraoral bone conduction hearing aids: Intraoral bone conduction Hearing Aids
Listed as unproven/not medically necessary
Laser or light-based hearing aids: Laser or light-based Hearing Aids
Listed as unproven/not medically necessary
Totally implanted middle ear hearing systems
Listed as unproven/not medically necessary

Equipment Upgrades

Operational rules for upgrades:

ALL of the following

Upgrades treated as new service: Equipment upgrades are equivalent to a new service.
Requires same documentation and clinical criteria as new requests
Change in condition: A change in the member's medical condition and equipment needs requires the same criteria as a new request.

Billing Rule

Over-the-counter hearing aids (age >=18) coverage rules

Some plans provide benefits for FDA‑approved over‑the‑counter hearing aids for covered persons age 18 and older without requiring a fitting by a licensed provider, a medical exam, or a prescription. Verify applicability by checking the member‑specific benefit plan document.

Documentation Required

Plan-specific coverage determination

Refer to the member‑specific benefit plan document to determine whether wearable, semi‑implantable, or implantable devices are covered. Note plan exclusions identified in benefit considerations (for example, FM systems are excluded).

Documentation Required

Confirm device-specific candidacy and audiologic thresholds

Document device‑specific candidacy and audiologic thresholds per device labeling. Required documentation includes preoperative audiometrics (PTA AC and BC at device‑specified frequencies), word recognition score, patient age, prior hearing aid experience where indicated, and symmetry criteria when applicable.

Documentation Required

Experience with appropriately fitted hearing aids

For devices such as Osia, Bonebridge, and certain Cochlear systems, document recommended prior experience with appropriately fitted air or bone conduction hearing aids before implantation when labeling or guidance recommends it.

Documentation Required

Audiometric documentation required

Document bone‑conduction (BC) and air‑conduction (AC) pure tone average thresholds (0.5, 1, 2, and 3 kHz) to demonstrate candidacy per policy/device thresholds.

PTA BC and AC measured at 0.5, 1, 2, and 3 kHz

Prior Authorization

Reference member-specific benefit plan

Before applying this policy, verify the member‑specific benefit plan document and any applicable federal or state mandates, since those govern coverage in the event of conflict.

Billing Rule

CPT code updates

Updated CPT codes 0951T, 0952T, 0953T, 0954T, and 0955T were added effective 07/01/2025. Use the updated CPT list as applicable for the procedure.

0951T
0952T
0953T
0954T
0955T

Sensorineural Hearing LossDamage to inner ear (cochlea) or auditory nerve; usually permanent and not correctable medically or surgically.

Mixed Hearing LossCombination of conductive and sensorineural hearing loss (damage in outer/middle ear plus inner ear/nerve).

Hearing AidSound‑amplifying device designed to aid people with a hearing impairment; includes semi‑implantable electromagnetic and bone‑anchored devices as classified by FDA.

PTAPure Tone Average (commonly calculated at 0.5, 1, 2, and 3 kHz).

BCBone Conduction (measurement of cochlear sensitivity via skull vibration).

ACAir Conduction (standard audiometric measurement via ear canal/air).

SSDSingle‑Sided Deafness: unilateral profound sensorineural deafness with normal hearing in the contralateral ear.

Normal hearing (per policy)PTA air‑conduction threshold (0.5,1,2,3 kHz) <= 20 dB HL.

Other non-implantable devices (informational): Other non-implantable bone-anchored and wearable devices discussed in policy (informational status)