Hearing Aids and Auditory Implants
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Medicare Advantage coverage policy governing payment and medical necessity for hearing aids and auditory implants (including cochlear, auditory brainstem, and osseointegrated implants) for UnitedHealthcare Medicare Advantage members.
No material clinical or coverage changes in this revision.
Coverage Criteria for Auditory Implants
Auditory Implants (Medical Necessity)
Covered when ALL of the following are met:
Devices must be used in accordance with FDA‑approved labeling and Medicare device coverage guidance (see Medicare Benefit Policy Manual, Chapter 14, §10 and Chapter 16, §100).
Hearing aids and auditory implants that do not meet the Auditory Implants coverage criteria are not covered. Some members may have a supplemental hearing-aid benefit; verify the member’s Evidence of Coverage to determine eligibility for those supplemental benefits. In addition, hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids are excluded from Medicare coverage per Section 1862(a)(7) of the Social Security Act and 42 CFR 411.15(d).
Totally implantable middle ear hearing systems are provided as an example of devices that are not covered when they do not meet the Auditory Implants criteria. Specifically, the policy lists the Esteem® Implantable Hearing System as a non-covered example.
Procedure and HCPCS Codes
| 69714 | Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor |
| L8690 | Auditory osseointegrated device, includes all internal and external components. |
| L8691 | Auditory osseointegrated device, external sound processor, excludes 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. |
Provider Requirements and Utilization Management
Prior authorization and utilization management
Medical necessity coverage determinations follow this UnitedHealthcare Medicare Advantage Medical Policy and applicable Medicare source materials; delegates managing utilization management/prior authorization must be followed when applicable.
- Applicable procedure and HCPCS codes include CPT 69714 and HCPCS L8690–L8692 for osseointegrated devices; prior authorization requirements may be managed by delegated entities.
Step therapy not applicable
No step therapy requirements apply to auditory implants under this policy.
Documentation and claim submission
Providers must retain or have access to appropriate documentation to support coverage and to submit accurate claims; follow the member-specific benefit plan document and any delegated prior authorization or billing instructions.
- Use this policy as a guide for medical necessity, documentation, and Medicare coding/billing requirements.
- Confirm member coverage via the member’s Evidence of Coverage (EOC) or customer service number on the member ID card.
Coverage exclusions and denial triggers
Hearing aids and auditory implants that do not meet the Auditory Implants criteria are not covered; hearing aids and examinations for prescribing, fitting, or changing hearing aids are excluded from Medicare coverage per Section 1862(a)(7) of the Social Security Act and 42 CFR 411.15(d).
- Examples of noncovered devices include totally implantable middle ear hearing systems (e.g., Esteem Implantable Hearing System).
- Check the Auditory Implants coverage criteria before billing; claims for excluded items risk denial.
Background
Auditory implants are prosthetic devices that restore or replace auditory function by substituting for the middle ear, cochlea, or auditory nerve. Common implant types include cochlear implants, auditory brainstem implants, and osseointegrated implants. These devices are indicated when conventional hearing aids are medically inappropriate or cannot be utilized because of congenital malformations, chronic disease, severe sensorineural hearing loss, or prior surgery; devices must be used in accordance with FDA-approved labeling and applicable Medicare device coverage guidance.
Definitions and Device Codes
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