UnitedHealthcare Hearing Aids Coverage Update

Coverage and Medical Necessity Criteria

Device-specific medical necessity references

Coverage and medical necessity references for device categories

Wearable Air Conduction Hearing Aids: For medical necessity clinical coverage criteria for Hearing Aids, refer to the Ohio Administrative Code Rule 5160-10-11 DMEPOS: hearing aids.

Reference to state rule for specific criteria.

Bone Anchored / Bone Conduction Hearing Aids: For medical necessity clinical coverage criteria, refer to the InterQual CP: Procedures - Hearing Device, Bone Anchored or Bone Conduction (Pediatric).

InterQual criteria referenced for medical necessity.

Semi-Implantable Hearing Aids: For medical necessity clinical coverage criteria, refer to the InterQual CP: Procedures, Hearing Device, Middle Ear.

InterQual criteria referenced for medical necessity.

Bilateral/Unilateral BAHA with headband/adhesive (no osseointegration): For medical necessity clinical coverage criteria, refer to the InterQual CP: Durable Medical Equipment Hearing Aids.

Non-osseointegrated BAHA references InterQual.

Unproven devices

Additional non-state-specific coverage stance

Unproven / Not Medically Necessary Devices: 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 due to insufficient evidence of efficacy.

Explicitly listed as unproven/not medically necessary.

Active middle ear implants and bone conduction devices — general appropriateness

Covered when ALL of the following are met (per professional society statements and device labeling):

General appropriateness: 1) Patient is an appropriate candidate per AAO-HNS guidance and device-specific labeling (e.g., moderate-to-severe hearing loss for active middle ear implants; conductive/mixed or select SSD for bone conduction devices). 2) Device-specific audiometric selection criteria are met (frequency-specific AC/BC thresholds, word-recognition scores, age limits where specified). 3) Conventional amplification has been evaluated and is not appropriate or does not provide sufficient benefit when required by device labeling. 4) Procedure is performed by a qualified otolaryngologist/head and neck surgeon as recommended by AAO-HNS.

Derived from AAO-HNS position statements and FDA professional labeling references.

FDA-indicated device criteria (examples)

Device-specific FDA-indicated coverage conditions (examples aggregated by device type).

General indications for bone-anchored/bone-conduction devices

PTA bone-conduction thresholds by device: Examples: <=45 dB HL (many devices, e.g., BP100), <=55 dB HL (Osia fitting range), up to <=65 dB HL for superpower processors.<=45 to <=65 dB HL
Exact threshold depends on model and sound processor.
Age requirements: Examples: some devices intended for patients >=5 years (e.g., BAHA processors), others >=12 years (Bonebridge, Osia), contact devices >=18 years (some middle ear implants).>=5, >=12, >=18 years depending on device
See device-specific sections and labeling.
SSD indications:

Refer to the Ohio Administrative Code for governing rules on coverage limits, exclusions, and repair provisions: OAC Rule 5160-10-01 addresses durable medical equipment, prostheses, orthoses, and supplies (DMEPOS) general provisions and coverage limitations, and OAC Rule 5160-10-02 addresses DMEPOS repair provisions. These Ohio rules supersede or govern benefit determination where state requirements apply and should be consulted when evaluating coverage or repairs for hearing devices.

Certain technologies are described in this policy as having insufficient high-quality evidence to support routine coverage. Examples called out include intraoral bone conduction hearing aids, laser or light-based hearing aids (e.g., the Earlens Contact Hearing Device), and totally implantable middle ear hearing systems. The document cites limitations such as small study populations, short follow-up, lack of randomization, and absence of concurrent comparison groups as reasons these device types are considered investigational or unsupported by robust evidence.

The SoundBite Hearing System (an intraoral bone conduction device) is no longer manufactured: Sonitus Medical filed for bankruptcy and ceased production, and as of the referenced updates there is no ongoing manufacturing of that system. Because the device is not available, it cannot be considered an option for current provision.

Examples of device types discussed in the policy include: intraoral bone conduction devices (e.g., SoundBite, an in‑mouth transducer paired with an external BTE component), laser/light‑based systems (e.g., the Earlens Contact Hearing Device that transmits sound via infrared light to a tympanic membrane transducer), and totally implantable middle ear systems (e.g., Esteem, Carina) which are fully implanted devices comprising internal sound processors, sensors, and drivers.

Available evidence for some of these device types is limited and of low quality. The policy summarizes that studies of intraoral bone conduction devices and totally implantable middle ear systems are often small, nonrandomized, single‑arm, and have short follow‑up; systematic reviews and retrospective series report mixed or modest benefits and emphasize the need for caution when extrapolating results to broader populations. These evidence limitations underlie the policy’s stance that routine coverage is not supported without stronger comparative data.

This policy excerpt does not repeatedly use the explicit phrase "not medically necessary" for every investigational device; instead, UnitedHealthcare states that it uses InterQual as the primary source for medical/surgical criteria and that federal, state (OAC), or contractual requirements govern benefit determinations. Where InterQual does not apply, UnitedHealthcare medical policies and utilization review guidelines may be used to inform coverage decisions.

Procedure, Supply, and Billing Codes

Bone Anchored and Fitting/Testing CPT CodesCPT

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 andlor 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 andlor 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.
92590	Hearing aid examination and selection; monaural.
92591	Hearing aid examination and selection; binaural.
92592	Hearing aid check; monaural.

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BAHA HCPCS CodesHCPCS

L8690	Auditory osseointegrated device , includes all internal and external components.
L8691	Auditory osseointegrated device, external sound processor, excludes transducerlactuator, replacement only, each.
L8693	Auditory osseointegrated device abutment, any length, replacement only.
L8694	Auditory osseointegrated device, transducerlactuator, replacement only, each.
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or ther means of external attachment.

BAHA HCPCS CodesHCPCS

L8690	Auditory osseointegrated device , includes all internal and external components.
L8691	Auditory osseointegrated device, external sound processor, excludes transducerlactuator, replacement only, each.
L8693	Auditory osseointegrated device abutment, any length, replacement only.
L8694	Auditory osseointegrated device, transducerlactuator, replacement only, each.
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or ther means of external attachment.

Bone Anchored and Fitting/Testing CPT CodesCPT

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 andlor 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 andlor 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.

Fitting and Testing HCPCS/CPTmixed

S0618	Audiometry for hearing aid evaluation to determine the level and degree of hearing loss.
V5010	Assessment for hearing aid.
V5011	Fitting/orientation/checking of hearing aid.
V5014	Repair/modification of a hearing aid.
V5020	Conformity Evaluation.

Totally/Semi-Implantable and Evaluation Codes (mixed)mixed

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.
69799	Unlisted procedure, middle ear.
S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear.
V5095	Semi-implantable middle ear hearing prosthesis.
S0618	Audiometry for hearing aid evaluation to determine the level and degree of hearing loss.
V5010	Assessment for hearing aid.

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Semi-Implantable Electromagnetic Hearing Aids (SEHA)CPT

69799	Unlisted procedure, middle ear.
S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear.
V5095	Semi-implantable middle ear hearing prosthesis.

Evaluation/Fitting Codesmixed

S0618	Audiometry for hearing aid evaluation to determine the level and degree of hearing loss.
V5010	Assessment for hearing aid.
V5011	Fitting/orientation/checking of hearing aid.
V5014	Repair/modification of a hearing aid.
V5020	Conformity Evaluation.

Wearable Hearing Aid V-codesHCPCS

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.
V5140	Binaural, behind the ear.

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Wearable Hearing Aid Accessories and Misc V-codesHCPCS

V5262	Hearing aid, disposable, any type, monaural.
V5263	Hearing aid, disposable, any type, binaural.
V5264	Ear moldlinsert; not disposable, any type.
V5265	Ear moldlinsert; disposable, any type.
V5275	.

Miscellaneous/Other Hearing Aid CodesHCPCS

V5267	Hearing Aid or assistive listening device/supplies/accessories, not otherwise specified (Note: For plans that cover hearing aids, this code requires manual review to determine what the item is before a coverage determination can be made:).
V5298	Hearing aid, not otherwise classified.

Device examples and FDA clearances (informational — no billing codes present in this section)mixed

No codes listed

Applicable CPT Codes AddedCPT

0951T	CPT code added per 09/01/2025 policy history
0952T	CPT code added per 09/01/2025 policy history
0953T	CPT code added per 09/01/2025 policy history
0954T	CPT code added per 09/01/2025 policy history
0955T	CPT code added per 09/01/2025 policy history

Totally Implantable Active Middle Ear Hearing Implant Codes (reference)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.

inv-18: Degree of Hearing Loss ranges

Normal-10 to 15 dB HL

Slight16 to 25 dB HL

Mild26 to 40 dB HL

Moderate41 to 55 dB HL

Moderately severe56 to 70 dB HL

Severe71 to 90 dB HL

Profound

Prior Authorization, Documentation, and Billing Actions

Prior Authorization

Prior Authorization Required

Prior authorization is required for implantable and semi-implantable hearing devices and certain bone-anchored hearing systems. Submit a prior authorization request before scheduling procedures or dispensing devices to avoid claim denials or delays.

Prior authorization must include device model and FDA indication information where applicable.
Confirm whether InterQual criteria are available and cite InterQual decision results on the request (see inv-28).

Documentation Required

Confirm Device-Specific Selection Criteria

Confirm device-specific selection criteria per the device's FDA labeling during the prior authorization review. Ensure the member meets all device-labeled eligibility requirements (audiologic thresholds, age limits, word recognition scores, middle ear/anatomic prerequisites, and prior hearing aid experience where specified).

Clinical Background

Hearing loss may be conductive, sensorineural, or mixed. Conductive hearing loss results from problems conducting sound through the outer or middle ear and is often medically or surgically correctable, whereas sensorineural hearing loss arises from damage to the inner ear or auditory nerve and is typically permanent. Hearing aids and related devices (including semi‑implantable electromagnetic and bone‑anchored systems) are intended to improve hearing by amplifying or otherwise transmitting sound, with the appropriate device choice depending on the type and degree of hearing loss.

Definitions and Device Descriptions

inv-36: Conductive Hearing Loss

DefinitionOccurs when sound is not conducted efficiently through the outer ear canal to the eardrum; often correctable medically or surgically.

Clinical implicationConductive loss may be amenable to medical or surgical correction, distinguishing it from SNHL.

Relation to device selectionCandidates with persistent conductive or mixed loss after correction may be considered for bone-conduction devices.

inv-37: Degree of Hearing Loss / Sensorineural Hearing Loss (SNHL)

DefinitionSensorineural hearing loss (SNHL) results from damage to the inner ear (cochlea) or auditory nerve and is typically permanent and not correctable surgically.

Degree ranges source

OpenPayer

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

Coverage and Medical Necessity Criteria

Procedure, Supply, and Billing Codes

Prior Authorization, Documentation, and Billing Actions

Clinical Background

Definitions and Device Descriptions