ModifiedUnitedHealthcarePolicy CS052ID.D

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

Policy governing coverage and clinical information for wearable, bone-anchored, semi-implantable, and fully implantable hearing aids and devices for members in the state of Idaho (including Idaho Medicaid Plus).

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052ID.D

Change TypeMaterial code removals and state-specific HCPCS fee‑schedule notation

Effective DateJun 1, 2026

Next Review Date

Key ActionVerify prior authorization requirements and whether specific HCPCS codes are covered under the Idaho Medicaid fee schedule before submitting requests.

SourceLink

POLICY UPDATE CHANGES

Removed CPT/HCPCS codes 92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, and V5275.

Added notation that many HCPCS codes (S2230, V5070, V5080, V5095, V5150, V5190, V5230, V5242–V5253, V5262, V5263, and V5267) are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by Idaho Medicaid.

Updated FDA and References sections to reflect current information.

Related Billing Codes

HCPCS-V5242-HEARING-AID-ANALOG-MONAURAL-CIC

HCPCS V5242: Hearing Aid, Analog, Monaural, CIC

HCPCS-V5254-DIGITAL-MONAURAL-CIC-HEARING-AID

HCPCS V5254: Hearing Aid, Digital, Monaural, CIC

HCPCS-V5040-BODY-WORN-BONE-CONDUCTION-HEARING-AID-MONAURAL

HCPCS V5040: Hearing Aid, Monaural, Body-Worn, Bone Conduction

HCPCS-V5257-DIGITAL-MONAURAL-BTE-HEARING-AID

HCPCS V5257: Hearing Aid, Digital, Monaural, BTE

HCPCS-V5095-SEMI-IMPLANTABLE-MIDDLE-EAR-PROSTHESIS

HCPCS V5095: Semi-implantable Middle Ear Hearing Prosthesis

HCPCS-V5060-MONAURAL-BEHIND-THE-EAR-HEARING-AID

HCPCS V5060: Monaural Behind-the-Ear Hearing Aid

HCPCS-V5265-EAR-MOLD-INSERT-DISPOSABLE

HCPCS V5265: Ear Mold/Insert, Disposable, Any Type

HCPCS-V5267-HEARING-AID-ASSISTIVE-LISTENING-ACCESSORY-NOS

HCPCS Level II V5267: Hearing Aid or Assistive Listening Device Accessory

HCPCS-V5253-DIGITAL-BINAURAL-BTE-HEARING-AID

HCPCS V5253: Digitally Programmable Binaural BTE Hearing Aid

CPT-0951T-ACTIVE-MIDDLE-EAR-IMPLANT-SURGERY

CPT 0951T: Implantation of Active Middle Ear Hearing Implant

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State-specificApplies only to Idaho

MultipleDevice classes

ExtensiveCodes referenced

IncludedFDA references

NumerousAudiometric thresholds cited

State-specificHCPCS non-coverage note

Coverage Criteria

Medical necessity (delegated to Idaho Medicaid Provider Handbook)

Covered when clinical criteria in the Idaho Medicaid Provider Handbook are met

Reference criteria: Medical necessity clinical coverage criteria for hearing aids and devices are defined in the Idaho Medicaid Provider Handbook, Provider Guidelines: Audiology Services; coverage requires meeting those clinical criteria.

Policy delegates specific medical necessity criteria to the Idaho Medicaid Provider Handbook; refer to that handbook for required documentation and eligibility rules.

Device-specific FDA-indicated coverage criteria (examples)

Device-specific indications per FDA clearance (examples below). Covered when ALL device-specific criteria are met as described:

General device eligibility

Age criteria vary by device (examples: Otomag Alpha 1 implant use: patients ≥5 years; Cochlear Baha Attract: patients ≥5 years for implant; BONEBRIDGE and some Osia systems: patients ≥12 years; nonimplantable soundband/softband: any age as specified).device-specific
See FDA indications in cited sources.
Hearing thresholds: PTA bone-conduction and/or PTA air-conduction thresholds must meet device-specific numeric limits (examples below): Otomag/Cochlear/BONEBRIDGE/Osia/Baha processors specify thresholds such as ≤45 dB HL, ≤55 dB HL, or ≤65 dB HL depending on processor/power variant; ADHEAR noninvasive device indicates PTA bone-conduction ≤25 dB HL.device-specific (examples provided)
See cited device sections for processor-specific cutoffs.
Bilateral candidacy symmetry: For bilateral fitting, bone-conduction thresholds should be bilaterally symmetric: average interaural difference <10 dB (measured at 0.5, 1, 2, and 3 kHz) or <15 dB at individual frequencies, per device labeling.<10 dB average or <15 dB individual
See device-specific FDA indications.
Single-sided deafness (SSD): Devices may be indicated for SSD when the contralateral ear has normal hearing (PTA air-conduction ≤20 dB HL) or when the patient cannot or will not use an air-conduction CROS device; device labeling specifies SSD indications.PTA air-conduction ≤20 dB HL
See device-specific SSD indications in cited sources.
Pre-implant trial recommendation: Prior experience with appropriately fitted air conduction or bone conduction hearing aids is recommended before receiving some implantable devices (e.g., BONEBRIDGE, Osia systems, and certain Baha implants).recommendation
Recommendation per device labeling and FDA summaries.

Codes in the policy that are labeled with an asterisk (*) are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by the State of Idaho Medicaid Program. For details on non-covered and excluded services, providers should consult the Idaho Medicaid Provider Handbook, General Information and Requirements for Providers: Non-Covered and Excluded Services.

Certain HCPCS codes referenced in this policy are not listed on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by Idaho Medicaid. Providers must refer to the Idaho Medicaid Provider Handbook for the current list of non-covered and excluded services and to confirm whether a specific HCPCS code is payable before submitting claims or authorization requests.

Listing a procedure or diagnosis code in this policy is for reference only and does not guarantee coverage or payment. Benefit coverage is determined by federal, state, or contractual requirements and applicable law, and inclusion of a code does not imply any right to reimbursement.

There are currently no FDA‑approved intraoral bone conduction hearing aids available. The SoundBite Hearing System, which received FDA clearance in 2011, ceased manufacturing after Sonitus Medical filed for bankruptcy in 2015.

Coding

Bone Anchored Hearing Aids (BAHA) CPTCPT

69710

Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone

CPT - Implantable and middle ear device codesCPT

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
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

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HCPCS - Wearable and osseointegrated device 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
S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear
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
V5120	Binaural, body

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HCPCS codes flagged as not on Idaho Medicaid Fee ScheduleHCPCS

S2230	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5070	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5080	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5095	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5150	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5190	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5230	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5242	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5243	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)
V5244	HCPCS code noted in policy (not on Idaho Medicaid Fee Schedule)

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CPT/HCPCS codes removed from policymixed

92590	Removed CPT code
92591	Removed CPT code
92592	Removed CPT code
92593	Removed CPT code
92594	Removed CPT code
92595	Removed CPT code
S0618	Removed HCPCS code
V5010	Removed HCPCS code
V5011	Removed HCPCS code
V5014	Removed HCPCS code

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Vibrant Soundbridge pure-tone thresholds (by frequency)

500 Hz30–65 dB HL

1000 Hz40–75 dB HL

1500 Hz45–80 dB HL

2000 Hz45–80 dB HL

3000 Hz50–85 dB HL

4000 Hz50–85 dB HL

Provider Actions and Documentation

Note

Coding reference and coverage determination

The codes listed in this policy are provided for reference only; inclusion in the policy does not guarantee that the service described by a code is a covered benefit or that the code will be reimbursed. Benefit coverage is determined by federal, state, or contractual requirements and applicable law.

Prior Authorization

Verify coding and authorization before submission

Confirm current coding and any prior authorization requirements with UnitedHealthcare and Idaho Medicaid before submitting requests, since CPT/HCPCS code changes were made and some codes may be affected.

Step Therapy

Step therapy not specified

Background

This policy summarizes the clinical coverage rationale and relevant FDA information for a range of hearing devices, including wearable, bone‑anchored, semi‑implantable, and fully implantable systems. It presents device‑specific FDA indications, examples of audiometric selection criteria (e.g., PTA bone‑ and air‑conduction thresholds), and references the Idaho Medicaid Provider Handbook for the state’s medical necessity criteria used to determine coverage.

Definitions

Vibrant Soundbridge — semi-implantable electromagnetic middle-ear device indications summary

Device classSemi-implantable electromagnetic middle-ear device (e.g., Vibrant Soundbridge, MAXUM)

FDA-approved populationAdults aged 18 years and older with moderate to severe sensorineural hearing loss (per device labeling)

Audiometric selection criteriaPure-tone air-conduction thresholds by frequency specified (500–4000 Hz ranges) and Word Recognition Score ≥50% for Vibrant

Anatomy and patient factorsNormal middle-ear anatomy and psychological/motivational suitability required

BAHA (Bone-Anchored Hearing Aid) — osseointegrated bone conduction hearing system summary

Device classOsseointegrated bone conduction hearing system (BAHA family and equivalents)

Revision History

2026-06-01codes_removed_and_fee_schedule_noteLatest

Removed CPT/HCPCS codes 92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, and V5275; added notation that multiple HCPCS codes (including S2230, V5070, V5080, V5095, V5150, V5190, V5230, V5242–V5253, V5262, V5263, and V5267) are not on the State of Idaho Medicaid Fee Schedule and therefore may not be covered by Idaho Medicaid; updated FDA and References sections; archived prior version CS052ID.C.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052ID.D

Change TypeMaterial code removals and state-specific HCPCS fee‑schedule notation

Effective DateJun 1, 2026

Next Review Date

Key ActionVerify prior authorization requirements and whether specific HCPCS codes are covered under the Idaho Medicaid fee schedule before submitting requests.

SourceLink

On This Page

BAHA candidate thresholds

General implant indicationPure-tone threshold hearing loss ≥45 dB HL for traditional BAHA implant; pediatric implant use approved for age ≥5 years

BP100/Baha 4/Baha 5 processorsPTA bone-conduction threshold ≤45 dB HL for indicated ear

BP110 Power/Baha 5 Power processorsPTA bone-conduction threshold ≤55 dB HL for indicated ear

Cordelle II/Baha 5 SuperPower processorsPTA bone-conduction threshold ≤65 dB HL for indicated ear

Single-sided deafness (SSD) definition for BAHA — contralateral ear normal hearing PTA ≤ 20 dB

SSD definition (contralateral ear)Normal hearing defined as PTA air-conduction ≤20 dB HL measured at 0.5, 1, 2, and 3 kHz

SSD intended benefitBAHA for SSD intended to improve speech recognition or for patients who cannot/will not use an air conduction CROS

Applicable age notesDevice-specific age criteria apply (see BAHA clearances; pediatric implant use from age 5 years for certain models)

PTA bone- and air-conduction thresholds (device-specific) — examples of threshold cutoffs

Common measurement frequenciesPTA measured at 0.5, 1, 2, and 3 kHz (some references include 4 kHz for symmetry calculations)

Bone-conduction PTA cutoffs (examples)≤45 dB HL, ≤55 dB HL, and ≤65 dB HL depending on processor/power variant

Interaural symmetry for bilateral fittingAverage difference <10 dB (0.5,1,2,3 kHz) or <15 dB at individual frequencies

Normal ear air-conduction referenceNormal hearing defined as PTA air-conduction ≤20 dB HL (0.5,1,2,3 kHz)

No explicit step therapy requirements are stated in this policy section.

Note

Recommendation: trial with conventional hearing aids

Prior experience with appropriately fitted air conduction or bone conduction hearing aids is recommended before some implantable devices (for example, BONEBRIDGE and Osia systems).

Documentation Required

Medical records required

Patient medical records must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures; records must be legible and available upon request.

Documentation Required

Audiometric thresholds required per device indications

Audiometric test results documenting PTA bone-conduction and PTA air-conduction thresholds, as specified per device indications (e.g., PTA bone-conduction thresholds ≤45 or ≤55 dB HL; normal ear PTA air-conduction ≤20 dB HL), should be available to establish device-specific eligibility.

Denial Risk

Documentation insufficiency

Lack of sufficient medical record documentation to support medical necessity may result in denial of the request or a requirement to submit additional documentation.

Denial Risk

State fee-schedule exclusions may trigger denial

Claims for HCPCS codes noted as not appearing on the State of Idaho Medicaid Fee Schedule may be denied by Idaho Medicaid; providers must check the Idaho Medicaid Provider Handbook for non-covered or excluded services before submitting claims.

Key indicationsPatients with external ear malformations, chronically draining ear, conductive or mixed hearing loss, or inability/unwillingness to use air conduction aid

Age indicationsPediatric implant use cleared for age ≥5 years for certain models; nonimplantable/transcutaneous options available from any age as specified

Audiometric thresholdsPTA bone-conduction thresholds commonly required ≤45, ≤55, or ≤65 dB HL depending on processor; SSD eligibility when contralateral PTA air-conduction ≤20 dB HL

PTA (pure tone average) thresholds — device-specific eligibility references measurement frequencies

Measurement frequenciesPTA values measured at 0.5, 1, 2, and 3 kHz (4 kHz may be used for symmetry calculations)

Typical bone-conduction PTA cutoffsExamples include ≤45 dB HL, ≤55 dB HL, and ≤65 dB HL depending on device/processor power

Symmetry requirement for bilateral fittingAverage interaural difference <10 dB (0.5–3 kHz) or <15 dB at individual frequencies

Normal-ear air-conduction referenceNormal hearing defined as PTA air-conduction ≤20 dB HL (0.5,1,2,3 kHz) for SSD indications

Single-sided deafness (SSD) — definition and typical audiometric definition

SSD definitionProfound sensorineural hearing loss in one ear with normal hearing in the opposite ear

Audiometric normal-hearing criterionContralateral ear PTA air-conduction ≤20 dB HL (measured at 0.5, 1, 2, and 3 kHz)

Device applicationSSD may be treated with BAHA/Bonebridge/Osia and nonimplantable bone conduction devices when patient cannot/will not use air conduction CROS

Intended benefitImprovement in speech recognition and sound awareness from the deaf ear side