UnitedHealthcare hearing aids coverage update

Coverage Summary

Scope: This policy applies to Tennessee Medicaid (TennCare) and CoverKids and only to individuals under 21 years of age. It covers wearable air-conduction hearing aids (ACHAs) as medically necessary, and a range of bone-conduction and semi-implantable devices (including non-implantable headband/adhesive bone conduction devices, partially or fully implantable bone-anchored systems, and semi-implantable electromagnetic middle-ear devices). The policy presents a mixed coverage stance: wearable ACHAs are proven and medically necessary; many bone-anchored and semi-implantable devices are covered when FDA-labeled indications are met or when the member is not a candidate for ACHAs; some technologies (intraoral bone conduction, laser/light-based aids, and totally implanted middle ear systems) are listed as unproven/not medically necessary.

Quick facts and thresholds

Covered Population Age LimitUnder 21

Device categories proven vs unprovenProven/medically necessary: 5 categories; Unproven/not medically necessary: 3 categories

Note about FDA-cleared/approved devicesPolicy specifies device use per FDA labeled indications and lists multiple FDA-cleared/approved devices

Effective date2025-08-01

Medical Necessity Criteria

General Applicability

Policy applies when ALL of the following are met:

ALL of the following

Member is covered by Tennessee Medicaid (TennCare) or CoverKids
Member is under 21 years of age (policy only applies to individuals under 21) (TennCare Rules 1200-13-13)

Medically Necessary — Wearable Air-Conduction Hearing Aids (ACHAs)

Covered when ALL of the following are met:

ALL of the following

Device is a wearable air-conduction Hearing Aid required for correction of a Hearing Impairment

Device Thresholds & Selection Criteria

Device thresholds and definitions

Vibrant Soundbridge PTA AC thresholds500 Hz: 30-65 dB; 1000 Hz: 40-75 dB; 1500 Hz: 45-80 dB; 2000 Hz: 45-80 dB; 3000 Hz: 50-85 dB; 4000 Hz: 50-85 dB

BAHA / BP100 BC PTA threshold≤ 45 dB HL (0.5,1,2,3 kHz)

Baha Attract BP100 / BP1100 distinctionsBP100: BC PTA ≤45 dB HL; BP1100 Power: BC PTA ≤55 dB HL; Cordelle II/Baha 5 SuperPower up to 65 dB HL

Bonebridge BC PTA threshold≤ 45 dB HL (0.5,1,2,3 kHz)

Osia System BC PTA threshold≤ 55 dB HL (0.5,1,2,3 kHz)

ADHEAR BC PTA threshold≤ 25 dB HL (0.5,1,2,3 kHz)

SSD contralateral (normal hearing) definition

Coding

Bone Anchored Hearing Aids (BAHA) CPT/HCPCSCPT|HCPCS

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.

Fitting and Testing of Hearing Aids (CPT)CPT

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 for hearing aid; monaural.
92595	Electroacoustic evaluation for hearing aid; binaural.

Totally Implantable Active Middle Ear Hearing Implant (Category III)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.

BAHA HCPCS L-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.
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment.

Hearing Aid V and S Codes (Durable Medical Equipment / Supply) and MiscHCPCS|mixed

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.
V5264	Ear mold/insert, not disposable, any type.
V5265	Ear mold/insert, disposable, any type.
V5275	Ear impression, each.
S2230	Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear.
V5095	Semi-implantable middle ear hearing prosthesis.

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FDA PMA / 510(k) device references (informational)mixed

P990052	Vibrant Soundbridge PMA reference (FDA)
P010023	Maxum Hearing Implant PMA reference (FDA)
K984162	Branemark/BAHA system 510(k)/clearance reference
K090720	BAHA BP100 510(k)
K132189	Sophono Otomag related 510(k/K filings
K131240	Cochlear Baha Attract 510(k)
DEN170009	Bonebridge de novo decision
K183373	Bonebridge 510(k)
K190589	Osia System 510(k)
K191921	Osia 2 System 510(k)

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Applicable CPT codes (updated)CPT

0951T	Newly added applicable CPT (per policy history)
0952T	Newly added applicable CPT (per policy history)
0953T	Newly added applicable CPT (per policy history)
0954T	Newly added applicable CPT (per policy history)
0955T	Newly added applicable CPT (per policy history)

Provider Actions & Documentation Requirements

Documentation Required

Age and program applicability documentation

Verify Medicaid program enrollment and member age before submitting requests. This policy applies only to TennCare/CoverKids members under 21 years of age; include evidence of program enrollment and the member's date of birth in the record.

Confirm TennCare or CoverKids enrollment for the member.
Document member date of birth and confirm age is < 21 years at time of request.

Prior Authorization

Equipment upgrade considered as new service

Equipment upgrades are treated as new services. Requests for upgrades must meet the same prior authorization requirements, clinical criteria, and documentation standards as initial device requests.

Submit prior authorization when requesting an equipment upgrade.
Include the same clinical documentation and audiologic data required for initial device approval.

Background & Evidence Summary

Background: The policy defines the major types of hearing loss—conductive (sound not conducted efficiently through outer/middle ear), sensorineural (SNHL) (inner ear or nerve pathway damage), and mixed (combination of conductive and sensorineural). Device types described include wearable air-conduction hearing aids (ACHAs), non-implantable bone conduction devices (headband/adhesive), partially implantable/sem i-implantable electromagnetic middle-ear devices, and implantable bone-anchored systems (percutaneous and transcutaneous). The evidence discussion emphasizes pediatric data and device trials where applicable (for example, studies and systematic reviews of bone-conduction devices and pediatric outcomes are summarized), noting variable quality and stronger pediatric emphasis for bone-conduction device evidence.

Evidence source	Summary
Cochrane (Ferguson et al. 2017)
Hearing aids effective for improving hearing-specific and general health-related quality of life and listening ability in adults with mild to moderate hearing loss (5 RCTs, 825 participants).
Multiple systematic reviews and cohort studies
Evidence supports benefit of bone conduction devices and semi-implantable implants in children/adults for indicated hearing loss, though quality and RCT data are limited for some devices (e.g., Bonebridge, pTCBIs).
BAHA Attract systematic review (Dimitriadis 2016)
10 studies, 89 cases; satisfactory hearing outcomes and low complication rate versus percutaneous devices; further robust trials needed.
Intraoral IOBC SoundBite (Gurgel 2015)
Prospective case series, 81 SSD patients, improved APHAB scores and high satisfaction; no serious adverse events; limitations: no control group, attrition.
Earlens CHA (Gantz 2017)
Single-arm trial 43 subjects (86 ears), 120 days, mean PTA4 change -0.40 dB (no loss), significant aided word recognition improvement; supported FDA clearance.
Totally implanted middle ear systems (systematic reviews and case series)
Mixed results with small samples: some improvements in functional gain and speech outcomes but higher complication rates, device failures, and insufficient high-quality evidence for definitive conclusions.

Definitions

Term	Definition
Conductive Hearing Loss
Occurs when sound is not conducted efficiently through the outer ear canal to the eardrum and the ossicles of the middle ear; often correctable medically or surgically.
Sensorineural Hearing Loss (SNHL)
Occurs when there is damage to the inner ear (cochlea) or nerve pathways; usually not medically or surgically correctable and is the most common type of permanent hearing loss.
Mixed Hearing Loss
Combination of conductive and sensorineural hearing loss—damage in outer/middle ear and inner ear or auditory nerve.
Hearing Aids
Sound-amplifying devices designed to aid people with hearing impairment; includes wearable, bone-anchored, and semi-implantable electromagnetic devices for purposes of this policy.
PTA
Pure tone average measured at specified frequencies (commonly 0.5, 1, 2, 3 kHz).
BC
Bone conduction.
AC
Air conduction.
SSD
Single-sided deafness: unilateral profound sensorineural deafness with normal hearing contralaterally.

Revision History

2025-08-01material_changeLatest

Supporting Information archived previous policy version CS052TN.R; updated list of applicable CPT codes to reflect quarterly edits and added CPT codes 0951T, 0952T, 0953T, 0954T, and 0955T.

FDA / Device-specific selection criteria (summary per device)

Device is indicated when ALL of the following per device labeling are met:

ALL of the following

Vibrant Soundbridge: Adults aged 18 or older; audiologic results consistent with moderate to severe sensorineural hearing loss; pure tone air conduction thresholds within device-specific ranges (see thresholds group); word recognition score of 50% or better using recorded material; normal middle ear anatomy; psychologically and motivationally suitable with realistic expectations.500 Hz: 30-65 dB; 1000 Hz: 40-75 dB; 1500 Hz: 45-80 dB; 2000 Hz: 45-80 dB; 3000 Hz: 50-85 dB; 4000 Hz: 50-85 dB
FDA professional labeling (Vibrant Soundbridge)
Maxum Hearing Implant: Adults aged 18 or older; audiologic results consistent with moderate to severe sensorineural hearing loss; desire for an alternative to an acoustic hearing device; prior experience with appropriately fit hearing aids.
FDA professional labeling (Maxum)
BAHA / Baha systems: Patients (including children ≥5 for some models) with malformations of external ear, chronically draining ear, PTA bone-conduction threshold ≥45 dB and/or inability/unwillingness to use air conduction hearing aid; bilateral implantation criteria require moderate to severe bilateral symmetrical conductive or mixed hearing loss or mixed hearing loss with BC thresholds better than 45 dB (symmetry definitions in labeling).BC PTA ≤45 dB HL (0.5,1,2,3 kHz) for many models; BP1100 up to 55 dB for some processors
FDA BAHA labeling and device-specific thresholds
ADHEAR system (non-invasive): Indicated for patients of all ages with conductive hearing loss or SSD via bone conduction; retained non-invasively via headband or adhesive; PTA bone-conduction should be better than or equal to 25 dB HL (0.5,1,2,3 kHz) and SSD contralateral normal hearing defined as AC PTA ≤20 dB HL (0.5,1,2,3 kHz).BC PTA ≤25 dB HL; AC PTA for contralateral ≤20 dB HL
FDA ADHEAR labeling
Bonebridge (MED-EL): Patients ≥12 years with conductive or mixed hearing loss with BC PTA ≤45 dB HL (0.5,1,2,3 kHz); bilateral fitting when symmetry criteria met; SSD indication when contralateral AC PTA ≤20 dB HL (0.5,1,2,3 kHz); recommended prior experience with appropriately fit air- or bone-conduction hearing aids.BC PTA ≤45 dB HL; AC PTA contralateral ≤20 dB HL
FDA Bonebridge labeling
Osia and Osia 2 Systems: Patients ≥12 years; conductive or mixed hearing loss with BC PTA ≤55 dB HL (0.5,1,2,3 kHz); bilateral fitting when symmetry criteria met; SSD indication when contralateral AC PTA ≤20 dB HL (0.5,1,2,3 kHz); recommended prior experience with appropriately fitted air- or bone-conduction hearing aids.BC PTA ≤55 dB HL; AC PTA contralateral ≤20 dB HL
FDA Osia labeling

OpenPayer

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

Coverage Summary

Medical Necessity Criteria

Device Thresholds & Selection Criteria

Coding

Provider Actions & Documentation Requirements

Background & Evidence Summary

Definitions

Revision History