This policy, CS052IN.09 (effective 08/01/2025), summarizes UnitedHealthcare Community Plan of Indiana’s state-specific coverage direction for hearing aids and related devices. It applies only to Indiana and directs clinicians to refer to the referenced InterQual® clinical practice (CP) modules for detailed medical necessity determinations: Durable Medical Equipment, Hearing Aids and the procedure-specific InterQual CP modules for Hearing Device, Bone Anchored or Bone Conduction and Hearing Device, Middle Ear for adult and pediatric indications. For wearable air-conduction hearing aids (including repair and replacement), the policy references the Indiana Health Coverage Programs Provider Reference Module: Hearing Services for state-specific criteria and operational rules.
The policy includes concise device descriptions, FDA clearance context, and evidence summaries. It notes FDA-labeled selection criteria for several semi-implantable and bone-anchored devices (for example, Vibrant Soundbridge and various BAHA, Bonebridge, Osia and Osia 2 system clearances) to provide informational context rather than to establish coverage solely on regulatory status. Examples of device-specific FDA information described in the policy include age and audiometric selection thresholds, device-specific fitting ranges, and SSD (single-sided deafness) criteria.
Device-level evidence assessments summarized in this policy identify limited or conflicting quality data for certain technologies. Specifically, the policy lists intraoral bone conduction devices (e.g., SoundBite), laser/light-based contact hearing devices (e.g., Earlens), and totally implantable middle ear systems (e.g., Esteem, Carina) as having limited or conflicting evidence; the policy states these are considered unproven and not medically necessary for treatment of hearing loss due to insufficient evidence of efficacy. Where higher-quality or regulatory evidence exists (for example, FDA clearance/approval and supportive trials or post-market studies), device indications and selection criteria are summarized to assist providers in documenting appropriateness.
Providers are required to document compliance with the InterQual CP criteria and Indiana state hearing services rules, including pre-implantation audiometric testing and device-specific thresholds or symmetry criteria when applicable. The policy history records a material update 08/01/2025 adding temporary CPT codes 0951T, 0952T, 0953T, 0954T, and 0955T to the applicable code list and archiving the prior Indiana-specific policy version (CS052IN.08).