CurrentUnitedHealthcarePolicy CS052NM.C

Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for New Mexico Only)

UnitedHealthcare New Mexico medical policy (CS052NM.C) governing coverage and medical necessity of wearable air-conduction hearing aids, bone-anchored hearing aids (implantable and non-implantable), semi-implantable electromagnetic hearing aids, and related devices; includes definitions, evidence summary, and applicable procedure and HCPCS/V codes. Applies only to New Mexico.

Policy Summary

PayerUnitedHealthcare

PolicyHearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for New Mexico Only)

Policy CodePolicy CS052NM.C

Change TypeCPT/HCPCS code updates (added 0951T–0955T)

Effective DateAug 1, 2025

Next Review Date

Key ActionDocument FDA labeled indications and device-specific audiometric criteria and confirm member is not a candidate for an air-conduction hearing aid when providing implantable or alternative devices.

POLICY UPDATE CHANGES

Updated list of applicable CPT codes to reflect quarterly edits; added 0951T, 0952T, 0953T, 0954T, and 0955T.

5Device types listed as covered when not ACHA candidates

3Device categories listed as unproven

60+Procedure/HCPCS/V codes referenced

limitedEvidence limited for some devices

Coverage Summary

UnitedHealthcare New Mexico policy CS052NM.C (effective August 1, 2025) governs coverage of wearable air‑conduction hearing aids (ACHAs), bone‑anchored hearing aids (implantable and non‑implantable), semi‑implantable electromagnetic hearing aids, and related devices for members in New Mexico only. Wearable ACHAs are considered proven and medically necessary as first‑line treatment. When ACHAs are not appropriate, a range of bone conduction and semi‑implantable electromagnetic devices are covered if used consistent with FDA labeling and device‑specific selection criteria. Certain device types — specifically intraoral bone conduction devices, laser or light‑based hearing aids, and totally implanted middle ear systems — are identified as unproven / not medically necessary due to insufficient evidence.

High‑level eligibility depends on device class and FDA‑cleared thresholds: many bone‑anchored and transcutaneous systems require specified bone‑conduction PTA limits (commonly ≤45 dB HL for several devices, with some systems cleared up to ≤55 dB HL or higher depending on processor), single‑sided deafness (SSD) candidacy requires the contralateral AC PTA defined as ≤20 dB HL, and bilateral fittings generally require symmetry between ears (<10 dB average or <15 dB at individual frequencies). Device labeling also includes age minimums for certain implants (examples: some BAHA devices cleared for ≥5 years; Bonebridge and Osia systems ≥12 years; some middle ear implants ≥18 years).

Note the policy excludes coverage of Hearing Aids for Alternative Benefit Package (ABP) members aged 21 and over. Coverage decisions require documentation of audiometric thresholds, word recognition scores, symmetry metrics, prior hearing‑aid experience where relevant, and evidence that the member is not a candidate for an air‑conduction hearing aid when implantable or alternative devices are requested.

Quick thresholds & scope facts

PTA BC threshold — common implantable/transcutaneous rangeMost devices: PTA bone-conduction (BC) ≤45 dB HL; some processors/devices allow higher limits (Osia/Osia2 fitting range ≤55 dB HL; certain Baha/SoundArc processors up to 55 or 65 dB HL)

ADHEAR (non‑implantable) PTA BC thresholdPTA BC ≤25 dB HL (0.5,1,2,3 kHz)

Otomag / Sophono PTA BC thresholdPTA BC better than 45 dB HL (0.5,1,2,3 kHz)

BAHA / Bonebridge / Baha BP100 PTA BC thresholdPTA BC ≤45 dB HL for many processors (BP100); BP110 Power/Baha 5 Power ≤55 dB HL; Cordelle II/Baha 5 SuperPower up to ≤65 dB HL (processor-dependent)

SSD definition / contralateral normal earSingle-sided deafness (SSD): profound SNHL in one ear with contralateral PTA AC ≤20 dB HL (0.5,1,2,3 kHz) — eligibility for bone conduction devices when AC CROS not usable

Symmetry for bilateral fittingLess than 10 dB average difference between ears (0.5,1,2,3 kHz) or less than 15 dB at individual frequencies

Device minimum ages (examples)BAHA/BP100: some devices cleared ≥5 years (Softband for <5 years); Bonebridge & Osia: patients ≥12 years; many semi‑implantable middle ear implants: adults ≥18 years

ADHEAR / non‑implantable scopeIntended for unilateral or bilateral conductive loss or SSD (non‑invasive adhesive/headband retention)

Equipment upgrades policy noteEquipment upgrades are treated as a new service — same criteria as new requests

Medical-Necessity Criteria

Baha / Bone-Anchored Sound Processors (Implantable)

Covered when ALL of the following are met:

Baha device class: Device is a Baha or other implantable/transcutaneous bone-anchored sound processor intended for bone-conduction hearing restoration.

Specific numeric thresholds referenced in device sections.

PTA BC eligibility: Patient has conductive or mixed hearing loss with bone-conduction thresholds within the indicated range for the specific device per FDA labeling (device-specific BC PTA thresholds vary by processor/system).varies by device

See device-specific nodes for numeric thresholds.

Symmetry definitions

Symmetry definitions (ANY of): Symmetrical bone-conductive thresholds defined as less than a 10 dB average difference between ears (measured at 0.5, 1, 2, and 3 kHz).<10 dB average
Or less than a 15 dB difference at individual frequencies.<15 dB at individual freqs

Bilateral fitting: For bilateral fitting: patient meets the above criterion in both ears and has bilaterally symmetric moderate to severe conductive or mixed hearing loss.

Non-Implantable Bone-Conduction Hearing Aids (Softband / Headband) - Baha Softband; Otomag Alpha 1(S)

Covered when ALL of the following are met (device-specific):

Non-implantable use: Device is used with a softband or headband (no implantation surgery).

Indication: Patient has conductive or mixed hearing losses and can benefit from amplification.

Pediatric Softband note: For Baha Softband (pediatric note): cleared for children younger than 5 years.

FDA cleared 2002

Otomag PTA BC: For Otomag Alpha 1(S): PTA bone-conduction (BC) threshold for the indicated ear should be better than 45 dB HL (measured at 0.5, 1, 2, and 3 kHz).PTA BC <45 dB HL

ADHEAR System (Non-Implantable Adhesive or Headband Bone-Conduction Device)

Covered when ALL of the following are met:

Device identity: Device is the ADHEAR system (non-invasive, retained with elastic headband or adhesive adapter).

Indications include unilateral or bilateral conductive hearing loss (chronic or temporary) or single-sided deafness.

ADHEAR PTA BC threshold: The pure tone average (PTA) bone-conduction hearing threshold (measured at 0.5, 1, 2, and 3 kHz) should be better than or equal to 25 dB HL.PTA BC ≤25 dB HL

ADHEAR SSD eligibility (ANY of): Single-sided deafness (unilateral profound sensorineural deafness) with normal hearing on the contralateral side; normal hearing defined as PTA AC ≤20 dB HL (0.5,1,2,3 kHz).PTA AC ≤20 dB HL

Not Medically Necessary / Unproven

The following are considered unproven and not medically necessary due to insufficient evidence of efficacy:

Unproven devices: Intraoral bone conduction Hearing Aids

Unproven devices: Laser or light-based Hearing Aids

Unproven devices: Totally implanted middle ear hearing systems

Equipment Upgrades

Upgrades as new requests: 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.

FDA and device-specific selection criteria (aggregated per device class)

Device labeling / FDA indications and patient selection criteria as stated in sources:

Vibrant Soundbridge: Adults aged 18 or older; audiologic results consistent with moderate to severe sensorineural hearing loss; specific pure tone air conduction thresholds by frequency (500 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); word recognition score ≥50% using recorded material; normal middle ear anatomy; psychologically and motivationally suitable.frequency-specific AC thresholds; WRS ≥50%

FDA labeling per Vibrant PMA

Maxum: Adults aged 18 or older; audiologic results consistent with moderate to severe sensorineural hearing loss; desire for an alternative to acoustic hearing device; prior experience with appropriately fit hearing aids.

FDA labeling

BAHA indications: BAHA system indications: adult patients with external ear malformations or chronically draining ear, PTA air-conduction threshold ≥45 dB and/or inability or unwillingness to use air conduction hearing aid; pediatric clearance for children ≥5 years (1999).

Other Devices (Totally Implanted Middle Ear - Esteem; Intraoral SoundBite; Contact Hearing - Earlens)

Device-specific FDA status and availability:

Esteem totally implanted middle ear hearing system: FDA approved.

SoundBite intraoral bone conduction hearing aid: received FDA clearance in 2011 but manufacturing ceased after Sonutis Medical bankruptcy (2015). Not currently available.

Earlens Contact Hearing Device: FDA cleared April 2016 for individuals 18 years and older with mild to severe sensorineural hearing impairment; provides 125 Hz - 10,000 Hz amplification.age ≥18; SNHL indication

Coding

Bone Anchored Hearing Aids (BAHA) CPT / HCPCS / UnlistedmixedCovered

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.
69799	Unlisted procedure, middle ear.
L8690	Auditory osseointegrated device, includes all internal and external components.
L8691	Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each.

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Fitting and Testing of Hearing Aids CPT / HCPCS / S / V codesmixedCovered

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.
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.

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Semi-Implantable Electromagnetic Hearing AidsmixedCovered

0951T	Totally implantable active middle ear hearing implant; initial placement, including mastoidectomy, placement of and attachment to sound processor.
0952T	Revision or replacement, with mastoidectomy and replacement of sound processor.
0953T	Revision or replacement, without mastoidectomy and replacement of sound processor.
0954T	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.
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 codesmixedCovered

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.

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Applicable CPT / HCPCS codes (updated)mixed

0951T	Added CPT category III code (listed as newly added in applicable codes)
0952T	Added CPT category III code (listed as newly added in applicable codes)
0953T	Added CPT category III code (listed as newly added in applicable codes)
0954T	Added CPT category III code (listed as newly added in applicable codes)
0955T	Added CPT category III code (listed as newly added in applicable codes)

Provider Actions

Documentation Required

FDA labeled indications and device selection

Devices used must be consistent with FDA labeled indications, contraindications, warnings, and precautions. Document that the member is not a candidate for an air‑conduction hearing aid when implantable or alternative devices are being provided; include device labeling justification and device‑specific selection criteria in the record.

Document FDA indication/labeling for the chosen device
State explicitly why the member is not a candidate for an air‑conduction hearing aid

Prior Authorization

Equipment upgrades treated as new requests

Equipment upgrades are treated the same as a new request; submit the same documentation and meet the same criteria as for an initial request when upgrading devices.

Provide full initial-request documentation when submitting an equipment upgrade

Documentation Required

ABP age exclusion

Verify payer/plan eligibility before ordering. Hearing Aids are not covered for Alternative Benefit Package (ABP) members age 21 and over; document member’s ABP status and age to confirm coverage exclusion.

Confirm and document member’s plan (ABP) eligibility and age

Documentation Required

Adhere to device-specific audiometric selection criteria

Document preoperative audiometric data required by device labeling. Include pure tone average (PTA) bone‑conduction (BC) and air‑conduction (AC) thresholds at specified frequencies, word recognition scores, symmetry metrics, and prior hearing‑aid experience when applicable.

PTA BC and AC at 0.5, 1, 2, and 3 kHz (some devices require 4 kHz or additional freqs)
Word recognition score (device examples: ≥50% for Vibrant Soundbridge)
Symmetry: <10 dB average difference (0.5,1,2,3 kHz) or <15 dB at individual freqs for bilateral fittings
Document prior experience with appropriately fitted air/bone conduction hearing aids when recommended

Documentation Required

SSD candidacy documentation

For single‑sided deafness (SSD) device indications, document contralateral ear air‑conduction PTA ≤20 dB HL (measured at 0.5, 1, 2, and 3 kHz) and record that the patient cannot or will not use an air‑conduction CROS device if that is the rationale for the implant.

Contralateral AC PTA (0.5,1,2,3 kHz) ≤20 dB HL
Note inability or refusal to use AC CROS as applicable

Documentation Required

Age verification per device labeling

Confirm and document patient age per device labeling before implantation or provision. Examples: BAHA/BAHA Attract/BP100 — cleared for patients aged ≥5 years (softband use in younger children); Bonebridge and Osia systems — patients ≥12 years; some middle ear implants and semi‑implantable devices — adults ≥18 years.

Record patient date of birth and cite device labeling that supports the minimum age requirement
If pediatric use is contemplated, document the specific device clearance and age allowance

Documentation Required

Audiometric documentation required

Include audiometric documentation that demonstrates device eligibility: PTA bone‑conduction and air‑conduction thresholds at 0.5, 1, 2, and 3 kHz (and 4 kHz where specified); device‑specific numeric thresholds (examples: ADHEAR BC PTA ≤25 dB HL; Otomag PTA BC <45 dB HL; Bonebridge BC PTA ≤45 dB HL; Osia BC PTA ≤55 dB HL).

PTA BC and AC at 0.5, 1, 2, and 3 kHz (add 4 kHz if device labeling requires)
Specify measured PTA values and compare to device‑specific thresholds (cite device model)

Prior Authorization

Prior authorization implied for device coverage decisions

Prior authorization is typically implied for device coverage decisions. Use the UnitedHealthcare medical policy and, if applicable, third‑party tools (e.g., InterQual) to support benefit administration; always check federal/state/and contractual benefit requirements before proceeding and document any plan‑specific requirements.

Refer to UnitedHealthcare Medical Policy for coverage rules
Use third‑party criteria tools where permitted
Verify and document federal/state/contractual requirements

Billing Rule

Use updated CPT codes

When billing, include the updated CPT category III codes (0951T–0955T) as applicable. This policy update (effective 08/01/2025) added codes 0951T–0955T; check for quarterly code edits and update billing accordingly.

Include CPT codes: 0951T, 0952T, 0953T, 0954T, 0955T when appropriate

Background & Evidence

Background definitions: Conductive hearing loss occurs when sound is not conducted efficiently through the outer or middle ear and may be correctable medically or surgically; sensorineural hearing loss (SNHL) results from damage to the inner ear or auditory nerve and is generally permanent; mixed hearing loss combines conductive and sensorineural components. Pure tone average (PTA) is the average of thresholds at commonly used frequencies (0.5, 1, 2, and 3 kHz). Symmetrical bone‑conductive thresholds are defined as <10 dB average difference between ears (0.5,1,2,3 kHz) or <15 dB at individual frequencies.

Device technology types described: ACHAs (standard wearable air‑conduction hearing aids) amplify sound via microphone/amplifier/receiver and are first‑line for non‑correctable hearing loss; non‑implantable bone conduction devices transmit vibration across the skin using headbands, softbands or adhesives (used for conductive/mixed losses and for trials in children and adults); semi‑implantable electromagnetic devices (e.g., Vibrant Soundbridge, Maxum) use implanted magnetic/ossicular stimulators to vibrate the ossicles for SNHL; implantable bone‑anchored systems include percutaneous (abutment) and transcutaneous magnetic coupling devices (e.g., BAHA, BAHA Attract, Bonebridge, Osia) that transmit vibration to the skull bone; intraoral bone conduction, laser/light‑based contact hearing devices, and totally implanted middle‑ear systems are separately discussed in the evidence sections, with intraoral, laser/light, and totally implanted middle‑ear categories noted as having limited or conflicting evidence.

Evidence source	Key finding
Cochrane review (Ferguson et al., 2017)	Hearing aids effective at improving hearing-specific and general health-related quality of life and listening ability in adults with mild-to-moderate hearing loss (5 RCTs, 825 participants).
Systematic reviews / HTAs (Bruchhage 2017; Butler 2013; ECRI 2024; Ontario Health 2020; Hayes, et al.)	Support benefit of semi-implantable electromagnetic devices, bone conduction devices, and implantable BAHA for indicated populations; evidence quality varies and randomized trials are limited.
Pooled functional gain metrics (Cooper & McDonald 2017; Magele et al. 2019)	pTCBI pooled weighted mean pure-tone average (PTA) gain ≈ 28.4 ± 2.1 dB and mean speech reception threshold (SRT) gain ≈ 32.9 ± 3.9 dB; meta-analyses show beneficial audiological performance with variable heterogeneity.
Earlens (light-driven Contact Hearing Device) trials (Gantz et al. 2017; Arbogast et al. 2019)	Mean functional gain ~31 dB across 2–10 kHz; word recognition improved by ~35% (rationalized arcsine units) in single-arm pivotal trial; FDA cleared (2016) for adults.
Carina fully implantable device (Peixoto et al. 2019; Pulcherio 2014)	Small cohort reports auditory gains ~15–20 dB at 1 year with greater gains in mixed hearing loss vs SNHL; studies limited by small size and lack of control groups.
Esteem totally implanted AMEI (Barbara 2018; Pulcherio 2014; Klein 2012; FDA PMA)	Long-term series report >80% maintaining auditory gains 10–30+ dB; complications/explants and revisions reported; FDA-approved device but evidence limited and nonrandomized.
FDA references / device labeling (Vibrant Soundbridge, Maxum, BAHA family, Otomag, Bonebridge, Osia, ADHEAR, Earlens, Esteem)	Device-specific labeled indications, age limits, and numeric audiometric thresholds are provided (e.g., Vibrant frequency-specific AC ranges; BAHA/ Bonebridge/Osia PTA BC thresholds and SSD AC ≤20 dB criteria).
Systematic reviews of implantable and transcutaneous BAHA and partially implantable systems (Kim 2017; Janssen 2012; Colquitt 2011)	BAHAs improve speech discrimination in noise and hearing-specific quality of life for conductive/mixed loss and SSD; bilateral BAHAs provide additional audiologic benefits versus unilateral in selected patients though overall evidence strength is limited.

Definitions (quick reference)

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

Sensorineural Hearing Loss (SNHL)Damage to inner ear (cochlea) or auditory nerve pathways; usually not medically/surgically correctable; most common permanent hearing loss

Mixed Hearing LossCombination of conductive and sensorineural components

Hearing Aids (policy definition)Sound‑amplifying devices including semi‑implantable electromagnetic and bone‑anchored devices for policy purposes

SSD (Single‑Sided Deafness)Profound SNHL in one ear with normal hearing in opposite ear; normal defined as PTA AC ≤20 dB HL (0.5,1,2,3 kHz)

PTA (Pure Tone Average)Average of hearing thresholds at specified frequencies (commonly 0.5, 1, 2, and 3 kHz)

BC (Bone Conduction)

OpenPayer

Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for New Mexico Only)

Coverage Summary

Medical-Necessity Criteria

Coding

Provider Actions

Background & Evidence

Revision History