ModifiedUnitedHealthcarePolicy CS052IN.11

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

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This policy governs coverage and medical-necessity review for wearable air-conduction hearing aids, bone-anchored or bone-conduction hearing aids, and semi-implantable hearing aids and related devices for UnitedHealthcare Community Plan members in Indiana.

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ModifiedUnitedHealthcarePolicy CS052IN.11

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

Customize your policy alerts

Sign up for UnitedHealthcare Policy CS052IN.11 alerts

Get alerted when Policy CS052IN.11 changes without checking for updates manually.

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Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052IN.11

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionApply the applicable Indiana Health Coverage Programs or InterQual clinical criteria based on the device and whether the criteria are state-specific.

SourceLink

POLICY UPDATE CHANGES

Medical necessity criteria for semi-implantable hearing aids were revised to require sensorineural hearing loss, inability to use an air-conduction hearing aid, and use according to FDA labeling.

The policy removed its reference to InterQual CP: Procedures, Hearing Device, Middle Ear.

The description of services, clinical evidence, and references sections were updated to reflect current information.

INApplicable state

4Primary device categories

5Unproven device types

20+Wearable hearing-aid codes

Medical Necessity and Coverage Criteria

Wearable Air Conduction Hearing Aids — State-Specific Criteria

For clinical coverage criteria, including repair and replacement criteria, refer to the Indiana Health Coverage Programs, Provider Reference Module: Hearing Services.

Indiana-specific criteria: Apply the Indiana Health Coverage Programs, Provider Reference Module: Hearing Services clinical coverage criteria, including repair and replacement criteria.

The applicable state-specific criteria are incorporated by reference.

Wearable Air Conduction Hearing Aids — Non-State-Specific Criteria

For medical-necessity clinical coverage criteria, refer to InterQual CP: Durable Medical Equipment, Hearing Aids.

Referenced medical-necessity criteria: Apply the InterQual CP: Durable Medical Equipment, Hearing Aids medical-necessity criteria.

The applicable non-state-specific criteria are incorporated by reference.

Bone-Anchored or Bone-Conduction Hearing Aids

For medical-necessity clinical coverage criteria, refer to the applicable InterQual procedures.

Applicable InterQual procedure: Apply the applicable InterQual CP: Procedures criterion for Hearing Device, Bone Anchored or Bone Conduction, or Hearing Device, Bone Anchored or Bone Conduction (Pediatric), as applicable.

Separate general and pediatric procedures are identified.

Semi-Implantable Hearing Aids

A semi-implantable electromagnetic hearing aid is proven and medically necessary when all of the following conditions are met.

All required conditions

The individual has hearing loss.
The individual is not a candidate for an air-conduction hearing aid.
The device is used according to U.S. Food and Drug Administration-labeled indications, contraindications, warnings, and precautions.

Bilateral or Unilateral Bone-Anchored Hearing Aids Without Osseointegration

For medical-necessity clinical coverage criteria, refer to InterQual CP: Durable Medical Equipment, Hearing Aids.

Referenced medical-necessity criteria: Apply the InterQual CP: Durable Medical Equipment, Hearing Aids medical-necessity criteria for bilateral or unilateral bone-anchored hearing aids utilizing a headband or adhesive without osseointegration.

The policy does not reproduce the detailed InterQual criteria.

Semi-Implantable Hearing Aid for Sensorineural Hearing Loss

A semi-implantable electromagnetic hearing aid is considered proven and medically necessary when all of the following are met.

All-of eligibility criteria

The individual has sensorineural hearing loss.
The individual is not a candidate for an air-conduction hearing aid.
The device is used according to U.S. Food and Drug Administration-labeled indications, contraindications, warnings, and precautions.

Intraoral bone-conduction hearing aids, laser or light-based hearing aids, and totally implanted middle-ear hearing systems are considered unproven and not medically necessary for treating hearing loss because of insufficient evidence of efficacy.

FDA approval or clearance alone is not a basis for coverage. Coverage remains subject to the applicable medical-necessity and benefit criteria.

There are currently no FDA-approved intraoral bone-conduction hearing aids. The SoundBite Hearing System received FDA clearance in 2011, but Sonitus Medical filed for bankruptcy in 2015 and manufacturing of the device ceased.

Intraoral bone-conduction hearing aids, laser or light-based hearing aids, and totally implanted middle-ear hearing systems are not medically necessary because they are considered unproven due to insufficient evidence of efficacy.

Covered Codes and Clinical Coding Parameters

Bone Anchored Hearing Aids (BAHA)CPT

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.
69799	Unlisted procedure, middle ear.

Semi-Implantable Electromagnetic Hearing Aids (SEHA)CPT

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.
0954T	Totally implantable active middle ear hearing implant; 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.

Bone Anchored Hearing Aids (BAHA)HCPCS

L8690	Auditory osseointegrated device, includes all internal and external components.
L8693	Auditory osseointegrated device abutment, any length, replacement only.
L8694	Auditory osseointegrated device, transducer/actuator, replacement only, each.

Semi-Implantable Electromagnetic Hearing Aids (SEHA)HCPCS

S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear.
V5095	Semi-implantable middle ear hearing prosthesis.

Wearable Hearing AidsHCPCS

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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Wearable Hearing AidsHCPCS

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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1/5

Degree of Hearing Loss

Normal-10 to 15 dBHL

Slight through moderately severeSlight: 16 to 25 dBHL; mild: 26 to 40 dBHL; moderate: 41 to 55 dBHL; moderately severe: 56 to 70 dBHL

Severe and profoundSevere: 71 to 90 dBHL; profound: 91 dBHL or more

Vibrant Soundbridge Air-Conduction Thresholds

500 Hz30 to 65 dB

1,000–2,000 Hz

Provider Review and Documentation Requirements

Documentation Required

Medical-Necessity Documentation Required

Ensure the patient's medical record fully supports the medical necessity of the requested services. Documentation must include relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures; it must be legible, maintained in the medical record, and available upon request. Documentation does not guarantee coverage.

Relevant medical history
Physical examination findings
Results of pertinent diagnostic tests or procedures
Legible records maintained in the patient's medical record and available upon request

Documentation Required

Qualified Specialist and Regulatory-Use Documentation

Document the qualified specialist's recommendation and confirm that device use follows applicable regulatory restrictions and guidelines. Recommendations for active middle-ear implants and bone-conduction devices should be made by a qualified otolaryngologist-head and neck surgeon, and use should comply with FDA or other applicable governing-agency requirements.

Policy Background

Hearing aids are sound-amplifying devices used to assist people with hearing impairment. For this policy, hearing aids include wearable devices, bone-anchored or bone-conduction hearing aids, semi-implantable electromagnetic hearing aids, and certain non-wearable hearing devices or systems. The policy addresses hearing loss that may be conductive, sensorineural, or mixed; conductive loss involves impaired sound transmission through the outer or middle ear, while sensorineural loss involves the cochlea or auditory nerve and is commonly permanent.

Hearing and Device Definitions

Conductive Hearing Loss

Site of impaired conductionOuter ear canal, eardrum, or ossicles of the middle ear

Typical effectReduction in sound level or ability to hear faint sounds

CorrectabilityCan often be corrected medically or surgically

Degree of Hearing Loss

Normal hearing-10 to 15 dBHL

Slight, mild, and moderate lossSlight: 16 to 25 dBHL; mild: 26 to 40 dBHL; moderate: 41 to 55 dBHL

Moderately severe, severe, and profound loss

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052IN.11

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionApply the applicable Indiana Health Coverage Programs or InterQual clinical criteria based on the device and whether the criteria are state-specific.

SourceLink

On This Page

1,000 Hz: 40 to 75 dB; 1,500 Hz: 45 to 80 dB; 2,000 Hz: 45 to 80 dB

3,000–4,000 Hz3,000 Hz: 50 to 85 dB; 4,000 Hz: 50 to 85 dB

Vibrant Soundbridge Word Recognition

Minimum word recognition score50% or better using recorded material

Assessment typeWord Recognition Score using recorded material

Related selection contextUsed in the Vibrant Soundbridge selection criteria

Bone-Anchored Device Thresholds

General thresholdBone-conduction PTA generally better than or equal to 45 dB HL

Applicable conditionsConductive or mixed hearing loss with ability to benefit from amplification

Device dependenceThe specific threshold depends on the device and indication

Baha and Related Device Thresholds

Baha Attract with BP100Better than or equal to 45 dB HL

Baha Attract with BP110055 dB HL

Baha 7Better than or equal to 55 dB HL

SoundArcAt least 45 dB HL with BP100, Baha 4, or Baha 5; 55 dB HL with BP110 Power or Baha 5 Power; at least 65 dB HL with Cordelle II or Baha 5 SuperPower

BONEBRIDGE and Osia Thresholds

BONEBRIDGEBetter than or equal to 45 dB HL at 0.5, 1, 2, and 3 kHz

Osia SystemBetter than or equal to 55 dB HL at 0.5, 1, 2, and 3 kHz

Osia 2 SystemBetter than or equal to 55 dB HL at 0.5, 1, 2, and 3 kHz

Symmetric Bilateral Fitting

Average interaural differenceLess than 10 dB

Individual-frequency differenceLess than 15 dB

ApplicationSymmetric bilateral fitting for conductive or mixed hearing loss

Baha BP100 Threshold

ThresholdBetter than or equal to 45 dB HL

Frequencies0.5, 1, 2, and 3 kHz

ProcessorBaha BP100

Baha SoundArc Thresholds

BP100, Baha 4, and Baha 5Better than or equal to 45 dB HL

BP110 Power and Baha 5 Power55 dB HL

Cordelle II and Baha 5 SuperPowerBetter than or equal to 65 dB HL

Frequencies0.5, 1, 2, and 3 kHz

Bilateral Bone-Conduction Symmetry

Average difference between earsLess than 10 dB

Individual-frequency differenceLess than 15 dB

Measurement frequenciesGenerally 0.5, 1, 2, and 3 kHz; the Otomag description specifies 0.5, 1, 2, and 4 kHz for average measurement

Normal Contralateral Hearing for SSD

PTA air-conduction thresholdBetter than or equal to 20 dB HL

Frequencies0.5, 1, 2, and 3 kHz

ApplicationNormal hearing in the contralateral ear for SSD indications

Otomag Threshold

ThresholdBetter than 45 dB HL

Frequencies0.5, 1, 2, and 3 kHz

DeviceOtomag Alpha 1(S) Sound Processor or Otomag system

ADHEAR Threshold

Bone-conduction thresholdBetter than or equal to 25 dB HL

Frequencies0.5, 1, 2, and 3 kHz

ApplicationConductive hearing loss or SSD via bone conduction

Active middle-ear implants: qualified otolaryngologist-head and neck surgeon involvement
Bone-conduction devices: recommendation by a qualified otolaryngology-head and neck surgeon
Follow FDA restrictions, guidelines, and approved indications

Denial Risk

Unproven Hearing-Device Types

The following hearing-device types are unproven and not medically necessary for treating hearing loss because of insufficient evidence of efficacy. Identify these device types in the request and advise that they may be denied.

Intraoral bone conduction hearing aids
Laser or light-based hearing aids
Totally implanted middle ear hearing systems

Documentation Required

Semi-Implantable Device Eligibility

A semi-implantable electromagnetic hearing aid for sensorineural hearing loss is proven and medically necessary only when used according to FDA-labeled indications, contraindications, warnings, and precautions, and when the individual is not a candidate for an air-conduction hearing aid.

Confirm sensorineural hearing loss
Confirm the individual is not a candidate for an air-conduction hearing aid
Document compliance with FDA-labeled indications, contraindications, warnings, and precautions

Documentation Required

Use Applicable Clinical Criteria

Apply the clinical criteria appropriate to the device and member's coverage context. For Indiana wearable air-conduction hearing aids, including repair and replacement, use the Indiana Health Coverage Programs Provider Reference Module: Hearing Services; also apply the referenced InterQual criteria where applicable.

Indiana Health Coverage Programs, Provider Reference Module: Hearing Services — wearable air-conduction hearing aids, including repair and replacement
InterQual CP: Durable Medical Equipment, Hearing Aids — wearable air-conduction hearing aids and bilateral or unilateral bone-anchored hearing aids using a headband or adhesive without osseointegration
InterQual CP: Procedures: Hearing Device, Bone Anchored or Bone Conduction
InterQual CP: Procedures: Hearing Device, Bone Anchored or Bone Conduction (Pediatric)

Billing Rule

V5267 Requires Manual Review

For plans that cover hearing aids, code V5267 requires manual review before a coverage determination can be made. Determine what the item is, then apply the applicable coverage and clinical criteria.

V5267 — Hearing aid or assistive listening device/supplies/accessories, not otherwise specified
Manual review is required to identify the item before determining coverage

Denial Risk

FDA Status Does Not Establish Coverage

FDA approval or clearance alone is not a basis for coverage. Make the coverage determination using the applicable benefit, contractual requirements, and clinical coverage criteria.

Do not treat FDA approval or clearance alone as establishing coverage

Denial Risk

Non-FDA-Approved Intraoral Device

An intraoral bone-conduction hearing aid presents a denial risk because there are currently no FDA-approved intraoral bone-conduction hearing aids. The SoundBite Hearing System received FDA clearance in 2011, but manufacturing ceased after Sonitus Medical filed for bankruptcy in 2015.

No FDA-approved intraoral bone-conduction hearing aids currently exist
SoundBite Hearing System: FDA-cleared in 2011; manufacturing ceased in 2015

Moderately severe: 56 to 70 dBHL; severe: 71 to 90 dBHL; profound: 91 dBHL or more

Hearing Aids

DefinitionSound-amplifying devices designed to aid people who have hearing impairment

Amplification technologyMay use analog or digital amplification

Policy classificationSemi-implantable electromagnetic hearing aids, bone-anchored hearing aids, and certain non-wearable hearing devices or systems are considered hearing aids for this policy

Hearing Impairment

DefinitionA reduction in the ability to perceive sound

RangeMay range from slight impairment to complete deafness

Clinical scopeDescribes reduced hearing ability across the severity spectrum

Mixed Hearing Loss

DefinitionConductive hearing loss occurring in combination with sensorineural hearing loss

Outer or middle ear componentDamage or dysfunction may occur in the outer or middle ear

Inner ear or nerve componentDamage or dysfunction may also occur in the inner ear (cochlea) or auditory nerve

Sensorineural Hearing Loss

CauseDamage to the inner ear (cochlea) or nerve pathways from the inner ear to the brain

Typical permanenceMost of the time, it cannot be medically or surgically corrected

Clinical descriptionThe most common type of permanent hearing loss

Intraoral Bone-Conduction Hearing Aid

Device typeNon-surgical intraoral bone-conduction hearing aid

ComponentsBehind-the-ear processor and removable, custom-fit oral retainer-like device

Sound transmissionTransmits sound through the teeth and skull bones to both cochleae, bypassing the outer and middle ear

Laser or Light-Based Hearing Aid

ProcessorBehind-the-ear sound processor

Signal conversionConverts sound into infrared light pulses

TransducerRemovable tympanic-membrane transducer converts the pulses into vibrations applied directly to the tympanic membrane

Semi-Implantable Electromagnetic Hearing Aid

External componentExternal sound processor receives and amplifies sound

Implanted componentImplanted magnetic device in the middle ear

MechanismElectromagnetic and static magnetic fields create ossicular vibrations that transmit sound to the inner ear

Totally Implanted Middle-Ear Hearing System

Implant locationImplanted behind the outer ear and in the middle ear

ComponentsImplanted sound processor, sensor, and driver

OperationThe driver converts electrical signals from the sound processor for transmission to the inner ear; the system does not use an external microphone or speaker

Single-Sided Deafness (SSD)

ConditionSingle-sided deafness or unilateral sensorineural hearing loss in one ear

Other earThe opposite ear has normal hearing

Normal-hearing criterionPTA air-conduction threshold equal to or better than 20 dB at 0.5, 1, 2, and 3 kHz

PTA

DefinitionPure-tone average threshold measured across specified frequencies

Common frequencies0.5, 1, 2, and 3 kHz

Use in this policyUsed in device indications and hearing-threshold criteria

Air-Conduction CROS

Device typeAir-conduction hearing aid

FunctionRoutes sound from the impaired side to the hearing ear

Clinical contextUsed as an alternative or comparator in selected SSD indications

SSD

DefinitionUnilateral sensorineural deafness in one ear

Opposite earNormal hearing in the opposite ear

Related optionAn air-conduction CROS hearing aid may be indicated, but some individuals cannot or will not use one

PTA

DefinitionPure-tone average hearing threshold measured at specified frequencies

Common frequencies0.5, 1, 2, and 3 kHz

Measurement typeAir-conduction or bone-conduction threshold, depending on the indication

Air-Conduction CROS Hearing Aid

Device typeHearing aid using air conduction

Routing functionRoutes sound from the poorer ear to the better-hearing ear

Transmission pathwaySound is routed through air conduction