CurrentUnitedHealthcarePolicy CS052TN.T

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

Defines medical necessity and coverage criteria for wearable air conduction hearing aids and various bone-conduction and semi-implantable hearing devices for Tennessee Medicaid and CoverKids; applies only to individuals under 21. Lists included and excluded device types, documentation requirements, definitions, background evidence summaries, and applicable procedure and supply codes.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052TN.T

Change TypeDocumentation requirements addedapplicable CPT/HCPCS codes removed

Effective DateJune 1, 2026

Next Review Date

Key ActionEnsure patient medical records document medical necessity with relevant history, exam, and diagnostic test results; make records legible and available upon request.

SourceLink

POLICY UPDATE CHANGES

Added language clarifying medical records documentation required for reviews and that coverage is determined by federal, state, or contractual requirements.

Updated definition of 'Conductive Hearing Loss'.

Removed list of applicable CPT/HCPCS codes for Fitting and Testing of Hearing Aids (92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, V5275).

Supporting Information section updated (Description of Services, Clinical Evidence, FDA, References) to reflect current information.

Under 21Eligible Age

3Not medically necessary (device types)

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Applicable CPT/HCPCS codes listed

limitedEvidence quality concerns

severalFDA-cleared/approved examples cited

removedCode Removals

Coverage Summary

Scope: Applies to Tennessee Medicaid and CoverKids (TennCare) and is limited to individuals under 21 years of age.

Stance: Mixed — wearable air conduction hearing aids are proven and medically necessary; many bone-conduction and semi-implantable devices are proven/medically necessary when used per FDA labeling or when the patient is not a candidate for air conduction hearing aids; some device categories are deemed unproven/not medically necessary because of insufficient evidence.

Effective date: June 1, 2026.

Included device families: wearable air conduction hearing aids; nonimplantable bone conduction (headband/adhesive/softband) devices; semi-implantable electromagnetic middle-ear devices; bone-anchored implants (percutaneous and transcutaneous, fully or partially implantable).

Excluded / not medically necessary device families: intraoral bone conduction devices; laser/light-based contact hearing devices; totally implantable middle-ear systems (considered unproven/not medically necessary per policy).

Quick-reference eligibility & thresholds

Eligible ageUnder 21

Common bone-conduction PTA eligibility<= 45 dB HL (many devices; some processors allow <=55 dB or <=65 dB)

OSIA / Osia 2 device PTA<= 55 dB HL

ADHEAR (adhesive) PTA eligibility<= 25 dB HL

Devices considered not medically necessary3 (Intraoral BCHAs; Laser/light-based devices; Totally implanted middle-ear systems)

Code removalsCPT/HCPCS removed: 92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, V5275

Medical Necessity Criteria

General Medical Necessity Criteria

Applies to members under 21 years of age; devices are proven and medically necessary when used per FDA labeling for indicated conditions or when the individual is not a candidate for air conduction hearing aid as specified:

ALL of the following

Age requirement: Patient is under 21 years of age (TennCare Medicaid, Chapter 1200-13.13-.10: Exclusions).
Wearable ACHAs: Wearable air conduction hearing aids required for correction of a hearing impairment are proven and medically necessary.
When not candidate for air conduction hearing aid, the following devices are proven and medically necessary when used according to FDA labeling
- Bilateral implantable BAHA:

Coding

Surgical/Procedure Codes (BAHA, Semi-implantable, Totally Implantable Middle Ear)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.
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.

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Durable Medical Equipment / HCPCS for BAHA and Related DevicesHCPCS

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.
V5095	Semi-implantable middle ear hearing prosthesis.
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.

Wearable Hearing Aid Supply Codes (V-codes)HCPCS

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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Removed codes (per revision)CPT|HCPCS

92590	Hearing aid examination and selection; monaural
92591	Hearing aid examination and selection; binaural
92592	Hearing aid check; monaural
92593	Hearing aid check; binaural
92594	Electroacoustic evaluation of hearing aid(s), monaural
92595	Electroacoustic evaluation of hearing aid(s), binaural
S0618	Hearing aid fitting and follow-up
V5010	Hearing aid, monaural, any type
V5011	Hearing aid, binaural, any type
V5014	Hearing aid, monaural: replacement for social/ cosmetic?

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Provider Actions

Documentation Required

Medical record documentation required

Patient medical record must contain documentation supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Documentation must be legible, maintained in the patient's medical record, and made available upon request.

Relevant medical history
Physical examination findings
Results of pertinent diagnostic tests or procedures
Records must be legible and available upon request

Prior Authorization

Equipment upgrades treated as new service

Equipment upgrades are considered equivalent to a new service; upgrades require the same prior authorization and must meet the same clinical criteria as a new request.

Background, Evidence & Definitions

This policy applies to TennCare Medicaid and CoverKids and is restricted to members under 21 years of age and defines medical necessity for wearable air conduction hearing aids and a range of bone-conduction and semi-implantable devices.

Device classes described include: wearable air conduction hearing aids; nonimplantable bone conduction devices (headband/adhesive/softband); semi-implantable electromagnetic middle-ear hearing aids (e.g., Vibrant Soundbridge, MAXUM); bone-anchored hearing aids (percutaneous and transcutaneous, including Baha, BONEBRIDGE, Osia); intraoral devices (SoundBite); laser/light-based contact hearing aids (Earlens); and totally implantable middle-ear systems (Esteem, Carina).

Evidence summary: Wearable air conduction hearing aids have randomized trial evidence supporting benefit for adults with mild-moderate loss (Cochrane). Bone-anchored and semi-implantable devices show audiologic and quality-of-life benefits in many observational studies and systematic reviews but the evidence quality varies (often low to moderate, with small cohorts and few randomized trials). Partially implantable transcutaneous devices show audiologic gains and generally low complication rates in systematic reviews, while percutaneous devices show meaningful gains but higher skin-related complications. Intraoral, laser/light-based, and totally implantable middle-ear systems have limited or conflicting evidence and are considered unproven/not medically necessary or have safety/complication concerns in available assessments.

Evidence	Key finding
Cochrane Review (Ferguson et al. 2017)
Hearing aids effective for improving hearing-specific and general quality of life in adults with mild–moderate loss (5 RCTs, 825 individuals).
Multiple systematic reviews and cohort studies
Support for benefit of bone-anchored and semi-implantable devices in conductive/mixed loss and SSD; evidence quality varies and is sometimes low or limited.
pTCBI systematic review pooled audiologic gains (Cooper & McDonald 2017)
Weighted mean PTA gain ~28.4 ±2.1 dB; mean SRT gain ~32.9 ±3.9 dB; minor complications 13.1%, implant extrusion/major complications 5.2%.
Active transcutaneous BCD meta-analysis (Magele et al. 2019 / ECRI 2024)
Reported beneficial audiological performance and high patient satisfaction with low complication rates; evidence overall low/very-low quality and nonrandomized.
Earlens contact hearing aid (Gantz et al. 2017; Arbogast 2019)
Mean functional gain 31 dB (2–10 kHz); no significant change in residual hearing (mean −0.40 dB PTA4); word recognition improved by ~35% RAU; FDA 510(k) clearance (2016).
Carina fully implantable device (Peixoto 2019 / 2023)
Functional gain 15–20 dB at 1 year; better results in mixed hearing loss; small sample (15 patients); device limitations and short follow-up noted.
Esteem totally implanted middle-ear system (ECRI 2025; systematic reviews)
Insufficient quantity/quality of evidence (<300 patients); reported serious adverse events including facial paralysis; conclusions uncertain.
FDA PMA / 510(k) references for Baha, Otomag, ADHEAR, BONEBRIDGE, Osia, Earlens, Esteem
Multiple FDA clearances and device-specific labeled audiometric thresholds cited (e.g., BAHA PTA bone conduction ≤45 dB HL; Osia/Osia2 ≤55 dB HL; Baha BP100 ≤45 dB HL; Baha 7 ≤55 dB HL; ADHEAR ≤25 dB HL; Vibrant Soundbridge air‑conduction ranges).
Systematic reviews / HTAs (ECRI, Hayes, Ontario Health, Cochrane and others 2011–2025)
Summaries note overall improvements in thresholds, speech perception and quality of life but study limitations (small samples, short follow-up, heterogeneity, lack of RCTs).

Conductive Hearing Loss: Sound is not conducted efficiently through the outer/middle ear; often correctable medically or surgically (policy definition).

Sensorineural Hearing Loss: Damage to the inner ear (cochlea) or nerve pathways; usually not correctable medically/surgically (policy definition).

Mixed Hearing Loss: Combination of conductive and sensorineural components (policy definition).

Revision History

06/01/2026documentation_addedLatest

Added language clarifying medical records documentation required for reviews: benefit coverage governed by federal/state/contractual requirements; patient medical record must contain legible documentation (history, exam, diagnostic tests/procedures) supporting medical necessity and made available upon request.

06/01/2026definition_updatedLatest

Updated definition of 'Conductive Hearing Loss' in the Definitions section.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052TN.T

Change TypeDocumentation requirements addedapplicable CPT/HCPCS codes removed

Effective DateJune 1, 2026

Next Review Date

Key ActionEnsure patient medical records document medical necessity with relevant history, exam, and diagnostic test results; make records legible and available upon request.

SourceLink

On This Page

Bilateral fully or partially implantable bone-anchored hearing aids for conductive or mixed hearing loss in both ears

Headband/adhesive BCHA: Bilateral or unilateral bone conduction hearing aids using a headband or adhesive (without osseointegration)

Semi-implantable electromagnetic hearing aid for sensorineural hearing loss

Unilateral implantable BAHA conductive/mixed: Unilateral fully or partially implantable bone-anchored hearing aids for conductive or mixed hearing loss in one or both ears

Unilateral implantable BAHA sensorineural: Unilateral fully or partially implantable bone-anchored hearing aids for sensorineural hearing loss in one ear

Exclusions (unproven/not medically necessary)

Intraoral BCHA: Intraoral bone conduction hearing aids
Laser/light-based: Laser or light-based hearing aids
(e.g., Earlens Contact Hearing Device)
Totally implanted middle-ear hearing systems

Documentation/Benefit Determination: Benefit coverage determined by federal, state, or contractual requirements; medical records documentation may be required to assess clinical criteria and must support medical necessity (history, exam, diagnostic tests) and be legible and available upon request.

FDA/Manufacturer Indications for Selected Devices

Device-specific labeled indications and audiometric thresholds per professional/FDA labeling:

Vibrant Soundbridge selection criteria: Adults aged 18 years or older; audiological results consistent with moderate to severe sensorineural hearing loss; pure-tone air conduction threshold levels within specified frequency ranges; Word Recognition Score of 50% or better; normal middle-ear anatomy; psychologically and motivationally suitable.500 Hz: 30-65 dB; 1,000 Hz: 40-75 dB; 1,500 Hz: 45-80 dB; 2,000 Hz: 45-80 dB; 3,000 Hz: 50-85 dB; 4,000 Hz: 50-85 dB

Per FDA professional labeling for Vibrant Soundbridge (PMA).

MAXUM Hearing Implant selection criteria: Adults aged 18 years or older; audiological results consistent with moderate to severe sensorineural hearing loss; desire for an alternative to an acoustic hearing device; experience with appropriately fit hearing aids.

Per FDA labeling for MAXUM (Soundtec/Maxum).

BAHA System (general) indications: Adults with malformations of the external ear or chronically draining ear; pure-tone threshold hearing loss of ≥ 45 dB; inability or unwillingness to use an air conduction hearing aid.

Initial BAHA clearances and pediatric extension to age 5+.

BAHA bilateral implantation (2001): Moderate to severe, bilateral, symmetrical conductive or mixed hearing loss; average bone conduction thresholds better than 45 dB HL; symmetry defined as <10 dB average or <15 dB at individual frequencies (500,1,2,4 kHz).

FDA 2001 bilateral indication.

BAHA for SSD (2002): Unilateral sensorineural deafness with normal hearing in the other ear; normal hearing defined as PTA air conduction ≤ 20 dB (0.5,1,2,3 kHz).

FDA 2002 SSD indication.

Sophono (Otomag Alpha 1) indications: Patients with conductive or mixed hearing loss benefiting from amplification; PTA bone conduction threshold better than 45 dB HL (0.5,1,2,3 kHz); bilateral fitting for symmetric loss with interaural diff <10 dB avg or <15 dB at individual frequencies; SSD criteria where hearing ear PTA air conduction ≤ 20 dB HL.

Per Otomag/Sophono FDA clearance (May 2011).

Cochlear Baha Attract indications (2013): Patients aged 5 years or older; conductive or mixed hearing loss with PTA bone conduction <=45 dB HL for BP100 processor and <=55 dB HL for BP1100 processor (0.5,1,2,3 kHz); bilateral fitting for symmetric losses; SSD: unilateral SN deafness with other ear PTA air conduction ≤20 dB HL.BP100 <=45 dB HL; BP1100 <=55 dB HL

Per Cochlear Baha Attract FDA clearance (2013).

BONEBRIDGE indications (2018/2019): Patients 12 years or older; conductive or mixed hearing loss with PTA bone conduction ≤45 dB HL (0.5,1,2,3 kHz); bilateral fitting for symmetrical loss (interaural diff <10 dB avg or <15 dB at individual frequencies); SSD criteria with hearing ear PTA air conduction ≤20 dB HL; recommended prior experience with appropriately fit air or bone conduction hearing aids.<=45 dB HL

Per BONEBRIDGE de novo/510(k) clearances.

Osia System / Osia 2 indications (2019): Patients 12 years or older; conductive or mixed hearing loss with PTA bone conduction ≤55 dB HL (0.5,1,2,3 kHz); bilateral fitting for symmetric loss; SSD criteria with hearing ear PTA air conduction ≤20 dB HL; recommended prior experience with appropriately fitted air or bone conduction hearing aids.<=55 dB HL

Per Osia FDA 510(k) approvals.

Baha nonimplantable/headband/softband indications: Any age may use SoundBand, Softband, or SoundArc; implants for age 5 and older; conductive or mixed hearing loss with PTA bone conduction thresholds per processor-specific limits (examples: <=45 dB HL for BP100/Baha 4/5; <=55 dB HL for BP110 Power/Baha 5 Power; <=65 dB HL for Cordelle II/Baha 5 SuperPower); bilateral fitting for symmetric losses; SSD criteria with hearing ear PTA air conduction ≤20 dB HL.<=45/55/65 dB HL depending on processor

Per Cochlear Baha FDA clearances and SoundArc/BP100/BP110 indications.

Cochlear Baha 7 Sound Processor (2025): Any age may use SoundBand/Softband/SoundArc; age 5+ for implant; conductive or mixed hearing loss with PTA bone-conduction ≤55 dB HL (0.5,1,2,3 kHz); bilateral fitting for symmetric moderate to severe loss; SSD criteria with hearing ear PTA air conduction ≤20 dB HL.<=55 dB HL

Per 2025 FDA clearance for Baha 7.

Nonimplantable Bone Conduction Hearing Aids (Baha family: BP100, Baha 4, Baha 5, BP110 Power, Baha 5 Power, Cordelle II, Baha 5 SuperPower)

Covered when ALL of the following are met:

General criteria: Patient has conductive or mixed hearing loss and can still benefit from sound amplification.

PTA bone conduction threshold criteria for specific sound processors

BP100/Baha 4/Baha 5: PTA bone conduction threshold (0.5,1,2,3 kHz) better than or equal to 45 dB HL for use with BP100, Baha 4, and Baha 5 sound processors<=45 dB HL
Per FDA BP100/Baha clearances
BP110 Power/Baha 5 Power: PTA bone conduction threshold better than or equal to 55 dB HL for use with BP110 Power and Baha 5 Power sound processors<=55 dB HL
Per FDA SoundArc/Baha processor indications
Cordelle II/Baha 5 SuperPower: PTA bone conduction threshold better than or equal to 65 dB HL for use with Cordelle II and Baha 5 SuperPower sound processors<=65 dB HL
Per device-specific indications

Fitting options: Bilateral fitting for patients who meet the above criterion in both ears with bilaterally symmetric, moderate to severe conductive or mixed hearing loss; unilateral SSD patients with normal hearing in the other ear (PTA air conduction threshold <= 20 dB HL at 0.5,1,2,3 kHz); Baha for SSD may be used for any patient indicated for an air conduction CROS who cannot or will not use an AC CROS.SSD: hearing ear PTA AC <=20 dB HL

Softband application: Use with Baha Softband (non-implant application) is acceptable; Softband cleared for children younger than 5 years (per FDA 2002 clearance).

No implantation surgery when used with Softband

Nonimplantable Bone Conduction Hearing Aids (Otomag Alpha 1(S) / Otomag Headband/Softband)

Covered when ALL of the following are met:

General indication: Patient has conductive or mixed hearing loss and can benefit from amplification.

PTA bone conduction threshold for indicated ear better than 45 dB HL (measured at 0.5, 1, 2, and 3 kHz).<=45 dB HL

Per Otomag Alpha 1(S) FDA clearance (May 2010).

Applicability for bilateral fitting: Bilateral fitting applicable for most patients with symmetric conductive or mixed hearing loss; symmetry defined as <10 dB average difference between left and right bone conduction thresholds (measured at 0.5,1,2,4 kHz) OR <15 dB difference at individual frequencies.

SSD criteria: Patients with profound sensorineural hearing loss in one ear and normal hearing in the opposite ear who will not or cannot use an air conduction CROS (PTA air conduction threshold of the hearing ear <=20 dB HL at 0.5,1,2,3 kHz).<=20 dB HL (AC)

Nonimplantable Bone Conduction Hearing Aids (ADHEAR system)

Covered when ALL of the following are met:

Intended population: Intended to treat patients of all ages with conductive hearing loss or single-sided deafness (SSD) via bone conduction.

Indications: Unilateral or bilateral conductive hearing loss, either chronic or temporary; PTA bone conduction threshold (0.5,1,2,3 kHz) better than or equal to 25 dB HL; SSD (unilateral profound sensorineural deafness) with normal hearing on contralateral side (PTA air conduction <=20 dB HL).PTA BC <=25 dB HL; SSD AC <=20 dB HL

Per ADHEAR FDA 510(k) clearance (April 2018).

Retention requirement: Retention via elastic headband or adhesive adapter placed behind auricle (noninvasive).

Noninvasive retention mechanism required for ADHEAR

Totally Implanted Middle-Ear Hearing System (Esteem)

Covered when device is FDA-approved/indicated and meets clinical criteria (policy references FDA approval):

FDA approval noted: Esteem prosthetic hearing restoration device is FDA approved.

Coverage requires device to be FDA-approved/indicated and meet clinical criteria.

Clinical criteria requirement: Device must meet the policy's clinical criteria for the indication when requested for coverage.

Medical records documentation and labeled indications apply.

Intraoral Bone Conduction Hearing Aid

Not covered / not available:

No FDA-approved intraoral devices: Currently no FDA-approved intraoral bone conduction hearing aids; SoundBite received FDA clearance in 2011 but manufacturing ceased after manufacturer bankruptcy in 2015.

Thus intraoral devices are not available/covered.

Laser or Light-Based Contact Hearing Aid (Earlens Contact Hearing Device)

Covered when ALL of the following are met:

FDA clearance and age: FDA cleared April 2016 via 510(k) for individuals aged 18 years or older with mild to severe sensorineural hearing impairment who can benefit from amplification.Age >=18

Earlens Contact Hearing Device 510(k) clearance.

Amplification range: Device provides amplification across 125 Hz to 10,000 Hz.125-10,000 Hz

Per FDA clearance and pivotal study findings.

Devices Considered Unproven / Not Medically Necessary

The following devices are considered unproven and not medically necessary due to insufficient evidence of efficacy:

Unproven / Not Medically Necessary Devices

Intraoral BCHA - unproven: Intraoral bone conduction hearing aids
Insufficient quality evidence and manufacturing cessation for SoundBite
Laser/light-based - limited evidence: Laser or light-based hearing aids (e.g., Earlens Contact Hearing Device)
Evidence limited; although Earlens cleared, policy lists laser/light-based devices among unproven/not medically necessary in Coverage Rationale
Totally implanted middle-ear - insufficient evidence: Totally implanted middle-ear hearing systems
Insufficient quality evidence and reports of serious adverse events (e.g., Esteem), per policy review

Documentation note: Devices listed as unproven/not medically necessary require evidence beyond current policy summaries to be considered for coverage.

Equipment Upgrades

Change in condition: A change in the member's medical condition and equipment needs requires the same criteria as a new request.

Equipment upgrades are equivalent to a new service.

Upgrades treated as new service for coverage determination.

Upgrades require same prior authorization/criteria as new requests

Documentation Required

Confirm device-specific audiometric criteria

Document that the patient meets device-labeled audiometric thresholds and other labeled selection criteria prior to implantation or fitting. Include age limits, device-specific pure-tone averages (air or bone conduction as labeled), word recognition scores, middle-ear anatomy, and prior hearing-aid experience where applicable.

Device-labeled PTAs (air or bone conduction) per manufacturer/FDA labeling
Age limits specified by device labeling
Word Recognition Score (WRS) requirements (e.g., VSB: WRS ≥ 50%)
Normal/acceptable middle-ear anatomy per device labeling
Prior hearing-aid experience when recommended

Documentation Required

Assess SSD candidacy per PTA definition

For single-sided deafness (SSD) candidacy, document the normal-hearing ear's PTA air conduction threshold and the patient’s inability or unwillingness to use an air-conduction CROS when applicable.

PTA air conduction of the normal-hearing ear ≤ 20 dB HL (0.5, 1, 2, 3 kHz)
Document reasons patient cannot or will not use an air-conduction CROS

Note

Counsel on risks and device limitations

Inform patients about limited or low-quality evidence for some devices and counsel them on potential adverse events and device limitations, including those reported for totally implantable systems.

Evidence may be limited or low quality for some device types
Potential adverse events: facial paralysis, device failures
May require battery replacement or surgical replacement

Documentation Required

Benefit determination governed by federal/state/contractual requirements

Benefit coverage is governed by applicable federal, state, or contractual requirements. When those requirements conflict with this policy, providers must reference and follow the federal, state, or contractual benefit rules.

Reference federal, state, or contractual benefit requirements when they differ from policy

Documentation Required

Medical records documentation requirement for coverage review

Medical records documentation may be required for coverage review. Patient records must fully support medical necessity, include relevant history, exam, and diagnostic test results, be maintained in the record, legible, and made available upon request.

Maintain documentation in the medical record
Make records available upon request for coverage review

Hearing Aids: Sound-amplifying devices to aid people with hearing impairment; for this policy includes wearable air conduction, semi-implantable electromagnetic, and bone-anchored devices.

PTA / Pure-Tone Average (PTA): Average hearing threshold across specified frequencies used to determine severity and device candidacy.

SSD (Single-Sided Deafness): Profound sensorineural deafness in one ear with normal hearing in the opposite ear (normal hearing defined as PTA air conduction ≤ 20 dB HL at 0.5, 1, 2, 3 kHz).

Symmetry: For bilateral fittings, symmetry is defined as less than a 10-dB average difference between ears (specified frequencies) or less than a 15-dB difference at individual frequencies.

Removed list of applicable CPT/HCPCS codes for fitting and testing of hearing aids (92590, 92591, 92592, 92593, 92594, 92595, S0618, V5010, V5011, V5014, V5020, V5264, V5265, V5275).

supporting_info_revisedLatest

Supporting Information updated (Description of Services, Clinical Evidence, FDA, References) to reflect current information.

archived_previous_policyLatest

Archived previous policy version CS052TN.S.