Hearing Aids and Devices Including Wearable, BoneAnchored, and Semi-Implantable (for Tennessee Only)

Coverage Summary

Scope: This policy governs coverage and medical necessity criteria for wearable, bone-anchored, semi-implantable, and related hearing aids and devices for TennCare Medicaid and CoverKids in Tennessee and applies only to individuals under 21 years of age.

Stance (high level): Wearable air conduction hearing aids (ACHAs) are the standard, proven, and medically necessary treatment when indicated. When ACHAs are not possible or appropriate, FDA-labeled implantable and nonimplantable alternatives (including bone-anchored devices, semi-implantable electromagnetic middle-ear devices, and nonimplantable bone conduction systems using headbands/adhesives or softbands) are covered if device-specific and FDA/clinical criteria are met. Certain device categories (notably intraoral bone conduction devices, laser/light-based devices, and totally implanted middle-ear systems) are identified as unproven and not medically necessary due to insufficient or conflicting evidence.

Evidence summary: The evidence base is mixed: systematic reviews, cohort studies, and device clearances support benefit for many bone-conduction and semi-implantable devices in selected indications, but study quality varies and randomized trials are limited. Multiple device types and models are discussed in the policy and FDA sections.

Eligible Age PopulationUnder 21

Headline PTA thresholds summaryDevice-specific PTA thresholds include: ADHEAR ≤25 dB BC; BP100/Baha4/Baha5 ≤45 dB BC; BP110/Baha5 Power ≤55 dB BC; Cordelle II/Baha5 SuperPower ≤65 dB BC; Otomag Alpha1 <45 dB BC; Osia ≤55 dB BC; BONEBRIDGE ≤45 dB BC

Devices listed as Not Medically Necessary3

Evidence strengthMixed

Medical-Necessity Criteria

General Coverage / Medical Necessity

Covered when ALL of the following are met:

ALL of the following

Member is under 21 years of age (TennCare Medicaid / CoverKids).
Wearable air conduction hearing aids required for correction of a hearing impairment.

Alternative Devices When Not Candidate for Air Conduction Hearing Aid

When not a candidate for an air conduction Hearing Aid and used according to FDA labeling, the following are proven and medically necessary:

ONE of

Bilateral fully or partially implantable bone-anchored Hearing Aids for Conductive or Mixed Hearing Loss in both ears.

FDA Indications and Selection Criteria (by device)

FDA Indications and Selection Criteria (by device type)

Device-specific FDA indications, selection criteria, model notes and approval dates (by device):

Vibrant Soundbridge

MAXUM Hearing Implant

BAHA System (general)

BAHA bilateral criteria: Moderate to severe bilateral symmetrical conductive or mixed hearing loss; <10 dB average or <15 dB in bone conduction thresholds at 500,1000,2000,4000 Hz; average bone conduction thresholds better than 45 dB HL.symmetry <10 dB avg or <15 dB at frequencies; BC avg <=45 dB HL

BAHA for SSD/unilateral SNHL: Unilateral sensorineural deafness in one ear with normal hearing in the other ear (PTA AC <=20 dB at 0.5,1,2,3 kHz); option when AC CROS cannot/will not be used.<=20 dB HL (0.5,1,2,3 kHz)

Coding

Wearable Hearing Aid Supply Codes (V-codes)HCPCSCovered

V5030	Hearing aid, monaural, body worn, air conduction.
V5040	Hearing aid, monaural, body worn, bone conduction.
V5050	Hearing aid, monaural, in the ear.
V5060	Hearing aid, monaural, behind the ear.
V5070	Glasses, air conduction.
V5080	Glasses, bone conduction.
V5100	Hearing aid, bilateral, body worn.
V5120	Binaural, body.
V5130	Binaural, in the ear.
V5140	Binaural, behind the ear.

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BAHA / Implantation CPTCPT

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 greater than or equal to 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 greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex.

Totally Implantable Middle Ear CPT (unlisted / procedure codes)CPT

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.

BAHA / Implantable Device Supply HCPCS (L-codes)HCPCS

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.

Semi-Implantable / Middle Ear HCPCS / CPTmixed

S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear.
V5095	Semi-implantable middle ear hearing prosthesis.

FDA clearance / device model references (informational)mixed

K984162	Branemark/BAHA System clearance (reference PMN)
K090720	BAHA BP100 clearance
K081606	BAHA Intenso (2008) reference
K042017	BAHA Divino (2004) reference
K100360	BA31300 implant / BA300 abutment (2010) reference
K082108	OBC Bone Anchored Hearing Aid System (Oticon Medical) 2008
K121228	Ponto Bone Anchored Hearing System (Oticon Medical) 2012
K211640	Ponto 5 Mini clearance (2021)
K102199	Otomag/Sophono clearance reference
K153391	Otomag related clearance reference

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Applicable CPT/HCPCS codes removed from policymixed

92590	Fitting and testing of hearing aids; separate listing
92591	Speech audiometry
92592	Hearing aid checks
92593	Speech recognition
92594	Real-ear measurement
92595	Hearing aid fitting
S0618	Hearing aid battery supply/related
V5010	Dispensing hearing aid, unilateral, programmable
V5011	Dispensing hearing aid, bilateral, programmable
V5014	Dispensing hearing aid, external, monaural

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Provider Actions

Documentation Required

Medical Records Documentation Required

Patient medical records must fully support medical necessity for requested hearing devices. Documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests; records must be legible and made available upon request.

Relevant medical history (hearing complaints, onset, prior treatments)
Physical exam findings (otoscopy, middle-ear status)
Pertinent diagnostic test results (audiograms, PTA, WRS, tympanometry)
Records must be legible and available upon request

Prior Authorization

Equipment Upgrades Treated as New Service

Equipment upgrades are processed and reviewed the same as a new service. Upgrades require meeting the same clinical criteria as new requests and therefore may be subject to prior review or authorization procedures.

Background & Evidence

This policy applies to Tennessee Medicaid (TennCare) and CoverKids and is restricted to beneficiaries under 21 years of age.

Rationale: Wearable air conduction hearing aids (ACHAs) are the standard treatment for hearing loss that cannot be corrected medically or surgically. When ACHAs are not possible or appropriate, the policy outlines covered alternatives — including fully or partially implantable bone-anchored systems, nonimplantable bone conduction devices (headband/adhesive/softband), and semi-implantable electromagnetic middle-ear hearing aids — when used according to FDA labeling and clinical criteria.

The policy also notes that some device categories are considered unproven and not medically necessary due to insufficient evidence (examples include intraoral bone conduction devices, laser/light-based hearing aids, and totally implanted middle-ear systems).

Operational note: Benefit coverage is determined by federal, state, or contractual requirements and applicable laws; medical records documentation may be required to demonstrate medical necessity (relevant history, physical exam, and diagnostic test results must be legible and available upon request).

Evidence	Finding/Value
Cochrane review (Ferguson et al. 2017)
Hearing aids effective for improving hearing-specific and general health-related quality of life and listening ability in adults with mild to moderate hearing loss (review of 5 RCTs, 825 individuals).
Multiple systematic reviews and cohort studies
Support benefits of bone conduction devices, semi-implantable devices, and active transcutaneous implants for conductive/mixed loss and SSD; evidence quality varies with lack of RCTs.
pTCBI PTA gain (weighted mean)
28.4 ±2.1 dB (weighted mean PTA gain for passive transcutaneous bone conduction implants).
pTCBI SRT gain (mean)
32.9 ±3.9 dB (mean SRT gain reported for pTCBIs).
SRT/functional gain (Earlens - Gantz 2017)
Mean functional gain 31 dB across 2–10 kHz; word recognition improved by 35% (rAU) in pivotal trial supporting FDA clearance.
Carina fully implantable middle-ear implant (Peixoto 2019/2023)
Auditory gain 15–20 dB at 1 year (greater improvements in mixed hearing loss); improved speech recognition in mixed-loss subgroup.
Esteem totally implanted middle-ear device adverse effects (Klein et al. systematic review)
Chorda tympani/taste disturbance ~30%; facial weakness ~8%; multiple explants/revisions reported; safety concerns and limited-quality evidence.
FDA references / device clearances
Numerous device-specific FDA 510(k)/PMA clearances and de novo decisions cited for Vibrant Soundbridge, MAXUM, BAHA/Baha systems, BONEBRIDGE, Osia, Earlens, Esteem, etc.; professional labeling provides selection criteria and thresholds.
Professional guidance (AAO-HNS, ASHA)
AAO-HNS considers active middle-ear implants and bone conduction hearing devices appropriate for selected adults; professional statements and ASHA resources referenced.

Definitions

Definitions:

Conductive Hearing Loss: Sound not conducted efficiently through outer ear canal to eardrum and ossicles; often correctable medically or surgically (ASHA).

Revision History

06/01/2026material_changeLatest

Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and applicable laws and that medical records documentation may be required to assess whether the member meets clinical criteria; medical record must fully support medical necessity (relevant history, physical exam, diagnostic test results), be legible, and made available upon request.

06/01/2026revised_definition

Updated definition of 'Conductive Hearing Loss' (Definitions section updated).

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