CurrentUnitedHealthcarePolicy 2026T0396II

Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare Commercial and Individual Exchange medical policy defining coverage rationale, definitions, applicable procedure and supply codes, benefit considerations, and evidence summaries for wearable air conduction hearing aids, nonimplantable and implantable bone conduction/anchored hearing aids, semi-implantable electromagnetic hearing aids, and totally implanted middle-ear systems. This part (1 of 3) includes policy identifiers, coverage rationale high-level statements, definitions, benefit considerations, applicable CPT/HCPCS/V codes and narrative evidence summaries.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy 2026T0396II

Change TypeCode removals; definitions and supporting content updated

Effective DateMar 1, 2026

Next Review Date

Key ActionDocument medical records and device-specific audiometric thresholds and age eligibility to demonstrate that the member meets clinical criteria for coverage.

SourceLink

POLICY UPDATE CHANGES

Updated Definition of 'Conductive Hearing Loss'.

Removed list of applicable CPT/HCPCS codes for Fitting and Testing of Hearing Aids (multiple codes listed).

Removed content/language pertaining to over-the-counter Hearing Aids from Benefit Considerations.

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information.

5Device types listed as proven/medically necessary (when not ACHA candidate)

Device types listed as unproven/not medically necessary

100+Applicable CPT/HCPCS/V codes listed

1Policy revision entry (03/01/2026)

13Removed CPT/HCPCS codes

Coverage Summary

Policy 2026T0396II (effective March 1, 2026) defines UnitedHealthcare Commercial and Individual Exchange coverage for hearing aids and related devices. The policy stance is mixed: wearable air-conduction hearing aids (ACHAs) are described as proven and medically necessary when required to correct a hearing impairment, while several alternative device categories are covered when FDA-labeled indications, contraindications, warnings, and precautions are met. Device categories addressed include: wearable ACHAs (standard amplification), nonimplantable bone conduction devices using a headband or adhesive (nonimplantable BCHA/BCD), implantable bone-anchored systems (percutaneous and transcutaneous/osseointegrated BAHA/osseointegrated implants), semi-implantable electromagnetic middle-ear devices (e.g., Vibrant Soundbridge, MAXUM), and totally implanted middle-ear systems (e.g., Esteem) as well as laser/light-based devices (e.g., Earlens) and intraoral systems (historical SoundBite).

Included device categories are explicitly listed in the coverage rationale and definitions: wearable air conduction devices are standard first-line therapy; nonimplantable bone conduction headband/adhesive devices and implantable bone-anchored systems (percutaneous and magnetic transcutaneous) are described as proven/medically necessary for patients who are not ACHA candidates; semi-implantable electromagnetic devices are FDA-classified as hearing aids and included when used per labeling; totally implanted middle-ear systems and intraoral/light-based devices are described in policy text with their regulatory status noted (some FDA-cleared/approved, some with limited or ceased manufacturing).

Policy-level summary statistics in the brief note multiple device categories and document recent administrative updates (including code removals and a 03/01/2026 policy revision), supporting the mixed coverage approach across device classes and the inclusion of device-specific selection criteria and thresholds in the policy.

Hearing degree thresholds (dB HL) - policy definitions

Normal hearing range-10 to 15 dB HL

Slight loss16 to 25 dB HL

Mild loss26 to 40 dB HL

Moderate loss41 to 55 dB HL

Moderately severe loss56 to 70 dB HL

Severe loss71 to 90 dB HL

Profound loss>= 91 dB HL

Medical Necessity & Coverage Rationale

Coverage Rationale - Wearable Air Conduction Hearing Aids

Covered when ALL of the following are met:

Hearing Aids required for the correction of a Hearing Impairment are proven and medically necessary.

Equipment Upgrades

Operational notes:

A change in the member's medical condition and equipment needs requires the same criteria as a new request.

Equipment upgrades are equivalent to a new service.

Not Medically Necessary / Unproven

The following are unproven and not medically necessary for treating hearing loss due to insufficient evidence of efficacy:

Device-Specific FDA Selection Criteria

Device-specific FDA Selection Criteria (summarized per device)

Selection criteria per manufacturer/FDA labeling (device-specific):

Vibrant Soundbridge selection criteria (any of listed required characteristics)

Adults aged 18 years or older
Audiological results consistent with moderate to severe sensorineural hearing loss
Pure-tone air conduction threshold levels within specified frequency ranges500 Hz: 30-65 dB; 1000 Hz: 40-75 dB; 1500 Hz: 45-80 dB; 2000 Hz: 45-80 dB; 3000 Hz: 50-85 dB; 4000 Hz: 50-85 dB
See thresholds node for exact frequency-level pairs

Device Indications (FDA-cleared summaries) & Background

FDA-cleared device summaries include: BAHA headband (cleared ~2000) for moderate to severe conductive losses and as a trial option; Cochlear Baha BP100 (cleared 2009) and Baha SoundArc (cleared 2017) processors with device-specific PTA bone conduction thresholds and bilateral symmetry criteria; Baha Softband/SoundBand for nonimplantable use and pediatric trials; Otomag Alpha 1 (Sophono) processors cleared for conductive/mixed losses with PTA bone-conduction threshold ≤ 45 dB HL and symmetry requirements; ADHEAR (noninvasive adhesive/headband) cleared with PTA bone-conduction threshold ≤ 25 dB HL; Cochlear Baha 7 Sound Processor cleared with nonimplantable indications and specified thresholds (e.g., PTA ≤ 55 dB HL for some processors); BONEBRIDGE and Osia systems cleared with device-specific PTA BC thresholds (e.g., BONEBRIDGE ≤ 45 dB HL, Osia ≤ 55 dB HL) and age minimums; Earlens Contact Hearing Device cleared April 2016 for ages ≥ 18 with mild to severe SNHL (125 Hz–10,000 Hz bandwidth); Esteem totally implanted middle-ear system is FDA approved (P090018); and the policy notes that there are currently no FDA‑approved intraoral BCDs in production following SoundBite’s manufacturer bankruptcy.

Background classifies devices by FDA designation and provides definitions of hearing-loss types and degree ranges. Key definitions include Conductive, Sensorineural, and Mixed Hearing Loss and hearing degree categories from Normal (-10 to 15 dB HL) through Profound (≥91 dB HL). The policy also defines hearing aids broadly to include semi-implantable electromagnetic and bone-anchored devices per FDA classification and includes PTA and SSD definitions used in device selection criteria.

Definitions & Audiometric Thresholds

Term	Definition
Conductive Hearing Loss
Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the small bones (ossicles) of the middle ear; usually involves a reduction in sound level or the ability to hear faint sounds and can often be corrected medically or surgically. (ASHA)
Sensorineural Hearing Loss
Occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain; most of the time cannot be medically or surgically corrected. (ASHA)
Mixed Hearing Loss
Combination of conductive and sensorineural hearing loss — damage may be in the outer or middle ear and in the inner ear (cochlea) or auditory nerve. (ASHA)
Hearing Aids
Sound‑amplifying devices designed to aid people with a hearing impairment; includes wearable air conduction devices as well as semi‑implantable electromagnetic and bone‑anchored devices as classified by the FDA. (Policy definition)
SSD
Single‑sided deafness/unilateral sensorineural deafness with normal hearing in contralateral ear; normal hearing defined as PTA air conduction ≤ 20 dB HL at 0.5, 1, 2, and 3 kHz. (Policy)
PTA
Pure‑tone average (commonly measured at 0.5, 1, 2, and 3 kHz).
pTCBI
Passive transcutaneous bone conduction implant. (abbreviation defined in policy)
BCD
Bone conduction device — device that transmits sound vibrations through the skull to the cochlea (policy usage).
Single‑Sided Deafness (SSD)
Unilateral sensorineural deafness in one ear with normal hearing in the other ear; normal hearing defined as PTA air‑conduction threshold ≤ 20 dB HL (0.5,1,2,3 kHz).
Symmetrical bone conduction thresholds
Less than a 10‑dB average difference between ears (measured at 0.5, 1, 2, and 3 kHz or at 0.5,1,2,3 and 4 kHz as specified) or less than a 15‑dB difference at individual frequencies. (Policy)

Device-specific PTA/PT thresholds and symmetry/SSD criteria

Vibrant Soundbridge (PTA air conduction) - per frequency500 Hz: 30–65 dB; 1000 Hz: 40–75 dB; 1500 Hz: 45–80 dB; 2000 Hz: 45–80 dB; 3000 Hz: 50–85 dB; 4000 Hz: 50–85 dB

BAHA / Osseointegrated implant (general)>= 45 dB HL (PTA) initial indication; bilateral symmetry: <10 dB avg or <15 dB at individual frequencies

BAHA BP100 (Cochlear Baha BP100)PTA bone conduction ≤ 45 dB HL (0.5,1,2,3 kHz)

Cochlear Baha Attract BP1100 (BP1100)PTA bone conduction ≤ 55 dB HL (0.5,1,2,3 kHz)

Cochlear Baha 7 (nonimplantable)PTA bone conduction ≤ 55 dB HL (0.5,1,2,3 kHz)

Baha SoundArc / BP100/Baha 4/Baha 5PTA BC ≤ 45 dB HL for BP100/Baha4/Baha5; ≤55 dB HL for BP110 Power/Baha5 Power; ≤65 dB HL for Cordelle II/Baha5 SuperPower

Applicable Codes

Bone Anchored Hearing Aids (BAHA) CPT/UnlistedCPT

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.
69799	Unlisted procedure, middle ear.

Totally Implantable Middle Ear Hearing Implant (Category III CPT)CPT

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 / Auditory Osseointegrated Device HCPCS L-codesHCPCS

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.

Semi-Implantable Electromagnetic Hearing Aids HCPCS/CPT/Othermixed

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

Wearable Hearing Aids HCPCS V-codes and L-codeHCPCS

L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.
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.

1–10 of 47

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Removed applicable CPT/HCPCS codes for Fitting and Testing of Hearing Aids (per 03/01/2026 summary)mixed

92590	Use of an audiometer
92591	Speech recognition
92592	Pure tone audiometry
92593	Electroacoustic evaluation
92594	Evaluation of central auditory function
92595	Hearing aid examination
S0618	Hearing aid fitting
V5010	External hearing aid, monaural
V5011	External hearing aid, binaural
V5014	External binaural hearing aid, digital

1–10 of 14

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Provider Actions & Documentation Requirements

Documentation Required

Medical records documentation required for reviews

Benefit coverage for health services is determined by the member-specific benefit plan document and applicable laws. Always refer to the member's benefit plan to confirm coverage, prior authorization requirements, benefit limits, member cost sharing, and any state-specific mandates. Medical records documentation may be required to assess whether the member meets clinical criteria for coverage; documentation alone does not guarantee payment.

Documentation Required

Adhere to device-specific selection criteria

Document the device-specific selection criteria used to determine candidacy and device choice. Include the member's age, detailed audiometric thresholds (air- and bone-conduction thresholds by frequency), whether hearing loss is symmetrical or asymmetric, the definition and documentation of single-sided deafness (SSD) if claimed, and the member's prior hearing-aid experience (type, dates, outcomes, and trial details).

Evidence Summary

Synthesis of the evidence: A Cochrane review shows hearing aids improve hearing-specific quality of life and listening ability in adults with mild to moderate loss, supporting ACHAs as first-line therapy. Observational studies and systematic reviews report benefits for bone conduction devices and semi-implantable middle-ear implants in conductive/mixed losses and SSD, but quality of evidence varies and randomized controlled trials are limited. Active transcutaneous BCDs demonstrate beneficial audiological performance, high patient satisfaction, and low complication rates in pooled series (reported minor event incidence ~1 per 9.9 person‑years; major events ~1 per 148.9 person‑years). Reviews of passive transcutaneous implants report mean PTA and SRT gains with major complication rates around 5.2% and minor around 13.1% in pooled reports, supporting careful selection. Intraoral BCHA (SoundBite) trials reported subjective improvements and high satisfaction but were limited by lack of control groups and subsequent cessation of manufacturing. Earlens light-driven contact hearing device trials showed improvements over unaided conditions and some benefits versus conventional hearing aids, supporting FDA clearance but noting trial limitations. Evidence for totally implanted middle-ear devices (Esteem, Carina) is limited by small sample sizes, heterogeneous designs, and notable adverse events in some reports (e.g., facial weakness, device failures), leading to insufficient high‑quality evidence for broad conclusions. Multiple ECRI and health-technology assessments have also reviewed specific products (Osia 2, Bonebridge, Esteem) and highlighted low- to very-low–quality comparative evidence and the need for more robust trials.

Revision History

03/01/2026revised_definitionLatest

Updated Definition of 'Conductive Hearing Loss' (part of Summary of Changes dated 03/01/2026).

03/01/2026removed_codesLatest

Removed applicable CPT/HCPCS codes for Fitting and Testing of Hearing Aids: 92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, V5275 (marked material).

03/01/2026removed_content

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy 2026T0396II

Change TypeCode removals; definitions and supporting content updated

Effective DateMar 1, 2026

Next Review Date

Key ActionDocument medical records and device-specific audiometric thresholds and age eligibility to demonstrate that the member meets clinical criteria for coverage.

SourceLink

On This Page

Intraoral bone conduction Hearing Aids

Laser or light-based Hearing Aids

Totally implanted middle-ear hearing systems

Word Recognition Score of 50% or better using recorded material

Normal middle-ear anatomy

Psychologically and motivationally suitable with realistic expectations

MAXUM Hearing Implant selection criteria

Adults aged 18 years or older
Audiological results consistent with moderate to severe sensorineural hearing loss
Desire for an alternative to an acoustic hearing device
Experience with appropriately fit hearing aids

BAHA System indications (generalized across clearances)

Adults with malformations of external ear, chronically draining ear, pure-tone threshold hearing loss of ≥ 45 dB, and/or inability/unwillingness to use air conduction hearing aidPTA BC ≥ 45 dB HL (general BAHA)
BAHA initial indication
Children 5 years or older (1999 clearance extension)
Bilateral implantation criteria: moderate to severe bilateral symmetrical conductive or mixed hearing loss (less than 10-dB average difference or less than 15 dB at individual frequencies) and average bone conduction thresholds better than 45 dBSymmetry: <10 dB avg or <15 dB at individual frequencies; BC ≤45 dB HL
SSD/unilateral sensorineural hearing loss: intended to improve speech recognition when other ear has normal hearing (PTA air conduction ≤ 20 dB at 0.5,1,2,3 kHz) or when AC CROS cannot be usedContralateral AC ≤20 dB HL

Otomag (Sophono) Otomag Alpha 1 indications

Patients with conductive or mixed hearing loss with PTA bone conduction threshold better than 45 dB HL (0.5,1,2,3 kHz)PTA BC < =45 dB HL
Bilateral fitting applicable for symmetric losses (difference <10 dB avg at 0.5,1,2,4 kHz or <15 dB at individual frequencies)Symmetry criteria as stated
Patients with profound SNHL in one ear and normal hearing in opposite ear (SSD), with PTA air conduction of hearing ear better than 20 dB HL (0.5,1,2,3 kHz) when AC CROS cannot be usedContralateral AC ≤20 dB HL

Cochlear Baha Attract indications

Patients aged 5 years or older
PTA bone conduction threshold ≤ 45 dB HL for BP100 processor, ≤ 55 dB HL for BP1100 (0.5,1,2,3 kHz)BP100 ≤45 dB HL; BP1100 ≤55 dB HL
Bilateral fitting for symmetric moderate to severe conductive or mixed hearing loss (symmetry defined as <10-dB3 avg difference or <15 dB at individual frequencies)Symmetry criteria as stated
SSD: PTA air conduction hearing threshold ≤ 20 dB HL (0.5,1,2,3 kHz) or indicated for AC CROS but cannot/will not use AC CROSContralateral AC ≤20 dB HL

BONEBRIDGE indications

Patients 12 years of age or older
PTA bone conduction threshold ≤ 45 dB HL (0.5,1,2,3 kHz)PTA BC ≤45 dB HL
Bilateral fitting for symmetric conductive or mixed loss (difference <10 dB avg at 0.5,1,2,3 kHz or <15 dB at individual frequencies)Symmetry criteria as stated
SSD: PTA air conduction hearing thresholds of hearing ear ≤ 20 dB HL (0.5,1,2,3 kHz) or indicated for AC CROS but cannot/will not use AC CROSContralateral AC ≤20 dB HL
Recommendation: prior experience with appropriately fit air conduction or bone conduction hearing aids

Osia/Osia 2 indications

Patients 12 years of age or older
PTA bone conduction threshold ≤ 55 dB HL (0.5,1,2,3 kHz)PTA BC ≤55 dB HL
Bilateral fitting for symmetric conductive or mixed loss (difference <10 dB avg or <15 dB at individual frequencies)Symmetry criteria as stated
SSD: PTA air conduction hearing thresholds of hearing ear ≤ 20 dB HL (0.5,1,2,3 kHz) or indicated for AC CROS but cannot/will not use AC CROSContralateral AC ≤20 dB HL
Prior experience with appropriately fitted air conduction or bone conduction hearing aids recommended

Cochlear Baha 7 Sound Processor (nonimplantable indications)

Patients of any age may use Baha SoundBand, Softband, or SoundArc
Patients aged 5 and older may use Baha osseointegrated implant system
PTA bone-conduction hearing threshold ≤ 55 dB HL (0.5,1,2,3 kHz) for use with Baha 7PTA BC ≤55 dB HL
Bilateral fitting for symmetric moderate to severe conductive or mixed loss (symmetry defined as <10 dB avg or <15 dB at individual frequencies)Symmetry criteria as stated
SSD: PTA air conduction hearing threshold of better than or equal to 20 dB HL (0.5,1,2,3 kHz)Contralateral AC ≤20 dB HL

Semi-implantable electromagnetic devices (Vibrant/MAXUM) common criteria: Adults aged 18 years or older; Moderate to severe sensorineural hearing loss per device-specific PTA ranges; Word recognition and prior hearing-aid experience/fit per device labelingRefer to device-specific PTA and WRS thresholds

When submitting documentation for device coverage, providers should clearly record the device-specific age eligibility and precise audiometric thresholds (e.g., PTA bone conduction and PTA air conduction at 0.5, 1, 2, and 3 kHz or as specified by the device). Reference the policy "thresholds" and the device-specific FDA selection criteria for exact frequency–level pairs, symmetry definitions, and SSD thresholds, and follow the provider actions section for required medical-record documentation and counseling notes.

Otomag (Sophono) Otomag Alpha 1PTA bone conduction better than 45 dB HL (0.5,1,2,3 kHz); bilateral symmetry <10 dB avg or <15 dB at individual frequencies

BONEBRIDGEPTA bone conduction ≤ 45 dB HL (0.5,1,2,3 kHz); bilateral symmetry <10 dB avg or <15 dB individual

Osia / Osia 2PTA bone conduction ≤ 55 dB HL (0.5,1,2,3 kHz); bilateral symmetry <10 dB avg or <15 dB individual

ADHEAR (noninvasive adhesive/headband)PTA bone conduction ≤ 25 dB HL (0.5,1,2,3 kHz)

Billing Rule

Hearing aid benefit limitations for wearable devices

For wearable hearing aids the payer will pay only for a minimally qualifying device that meets the policy's medical necessity criteria. Members are financially responsible for any optional upgrades, accessories, or enhanced features not required to meet the clinical indication. Document which features are clinically required versus elective and ensure billing reflects payer-covered baseline device components only.

Documentation Required

Equipment upgrades treated as new service

Equipment upgrades are treated as a new service. Requests for upgrades must meet the same clinical criteria and documentation requirements as an initial device request, including current audiometric data and justification for the upgrade based on medical necessity rather than desire for improved technology.

Documentation Required

Report adverse events and long-term device issues

Document any adverse events, device failures, infection, surgical complications, persistent pain, chronic skin issues, or long-term device-related problems. Report serious adverse events to the device manufacturer and follow FDA reporting guidance when applicable. For otologic or implant-related events, consider AAO‑HNS reporting recommendations and include dates, clinical course, interventions, and outcomes in the record.

Documentation Required

Refer to FDA device indications and thresholds

Document the audiometric measurements used to establish candidacy and to match device indications — specifically pure tone averages (PTA) calculated at the frequencies specified by device labeling (commonly 0.5, 1, 2, and 3 kHz or as otherwise specified). Record air- and bone-conduction thresholds, speech recognition scores, and any masking used. Ensure the measured thresholds and speech scores align with the FDA-labeled indications for the proposed device.

Documentation Required

Device-specific age and candidacy documentation

Document age eligibility and candidacy rationale for device-specific requirements (for example, minimum age per device labeling). If selecting a nonimplantable option when an implantable device is otherwise indicated, document the medical rationale, contraindications to implantation, or member preference after informed counseling.

Documentation Required

Counseling and expectation management

Document counseling provided to the member about realistic outcomes, device limitations, expectations for benefit, and the member's psychological and motivational suitability when relevant to device labeling. Record discussions about alternative treatments, hearing-rehabilitation services, and ongoing maintenance needs.

Removed content/language pertaining to over-the-counter Hearing Aids from Benefit Considerations (administrative/content removal).

03/01/2026revised_supporting_informationLatest

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information; previous policy version 2026T0396HH archived.