CurrentUnitedHealthcarePolicy MMP394.14

Hearing Aids and Auditory Implants

Medicare Advantage coverage guidance for hearing aids, osseointegrated implants, cochlear and other auditory implants, and related exclusions; applies to UnitedHealthcare Medicare Advantage members and providers submitting claims for these devices and services.

Policy Summary

PayerUnitedHealthcare

PolicyHearing Aids and Auditory Implants

Policy CodePolicy MMP394.14

Change TypeMaterial revisions and additions

Effective DateAug 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization when required and document that hearing aids are medically inappropriate before billing for an auditory implant.

SourceLink

POLICY UPDATE CHANGES

Auditory implants section modified to state certain devices that replace the function of the middle ear, cochlea, or auditory nerve are payable by Medicare as prosthetic devices and are indicated only when hearing aids are medically inappropriate or cannot be utilized.

Examples of osseointegrated implant brand name devices (Baha, Ponto, Bonebridge) were added.

Clarified coverage criteria and added references to Medicare manuals and FDA labeling to guide device use and coverage determinations.

3prosthetic device categories listed

3Medicare manual chapters referenced

3osseo brand examples

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Coverage Criteria for Auditory Devices

Auditory Implants (medical necessity)

Covered when ALL of the following are met

General coverage rule: Device replaces function of the middle ear, cochlea, or auditory nerve and is used as a prosthetic device

Certain devices that produce perception of sound by replacing these functions are payable by Medicare as prosthetic devices.

Indication after hearing aids: Hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss, or surgery

These implants are indicated only when hearing aids are medically inappropriate or cannot be utilized.

Device type examples: Includes cochlear implants, auditory brainstem implants, and osseointegrated implants

Cochlear/auditory brainstem implants replace cochlear or auditory nerve function via implanted electrode arrays; osseointegrated implants replace middle ear function and provide mechanical energy to the cochlea via a transducer.

FDA labeling and Medicare device rules: Device must be used in accordance with FDA-approved labeling and applicable Medicare device coverage rules

Refer to the Medicare Benefit Policy Manual (Chapter 16, §100 and Chapter 14, §10) and Devices@FDA for device-specific information.

Claims for hearing aids and for examinations performed for the purpose of prescribing, fitting, or changing hearing aids are excluded from Medicare payment. This exclusion is based on Section 1862(a)(7) of the Social Security Act and is restated at 42 CFR 411.15(d), which explicitly bars payment for hearing aids and related fitting/changing examinations.

Hearing aids and auditory implants that do not meet the Auditory Implants criteria are not covered. Examples include devices intended solely as amplifying hearing aids (air- or bone-conduction amplifiers) and other systems that do not function as prosthetic replacements of the middle ear, cochlea, or auditory nerve. The policy notes that some devices commonly described as hearing aids (including certain totally implantable middle ear hearing systems) are non-covered under these rules.

Coding and Billing References

Covered CPT Codes (referenced)CPT

69714

Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor

HCPCS L-codes (referenced)HCPCS

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 Responsibilities and Operational Notes

Prior Authorization

Prior authorization may be required

Prior authorization or other utilization management requirements may apply per the member's Medicare Advantage plan or delegate; follow the delegate's requirements where applicable.

Prior authorization requirements vary by Medicare Advantage plan or plan delegate.
If a delegate manages utilization, follow the delegate's prior authorization process.

Step Therapy

Implants only after hearing aids deemed inappropriate

Auditory implants are indicated only when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss, or surgery.

Implants are considered payable by Medicare as prosthetic devices only in these circumstances.
Examples include cochlear implants, auditory brainstem implants, and osseointegrated implants.

Background and Scope

Auditory implants and osseointegrated devices provide sound perception by replacing the function of the middle ear, cochlea, or auditory nerve and may deliver electrical or mechanical energy to auditory pathways. When they meet Medicare’s definition as prosthetic devices, these implants can be payable by Medicare, but only when hearing aids are medically inappropriate or cannot be utilized and when devices are used in accordance with applicable FDA labeling and Medicare device coverage rules. Examples of device categories include cochlear and auditory brainstem implants (electrical stimulation via implanted electrode arrays) and osseointegrated implants (skull-anchored systems that transmit mechanical energy to the cochlea).

Device Definitions

Cochlear/auditory brainstem implants — key definition and characteristics

DefinitionDevices that replace cochlear or auditory nerve function and provide electrical energy to auditory nerve fibers and other neural tissue via implanted electrode arrays (cochlear implants and auditory brainstem implants)

Medicare classificationPayable by Medicare as prosthetic devices when criteria are met

IndicationIndicated only when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss, or surgery

Functional mechanismProvide electrical stimulation to neural tissue via implanted electrode arrays to produce perception of sound

Reference guidanceSee Medicare Benefit Policy Manual, Chapter 16, §100 - Hearing Aids and Auditory Implants for coverage details