UnitedHealthcare hearing device coverage update

Covered devices / Medical necessity

Covered when ALL of the following are met

General coverage: Wearable air-conduction hearing aids required for the correction of a hearing impairment are proven and medically necessary.

From Coverage Rationale.

Alternative devices when not a candidate for air-conduction hearing aid: When used according to FDA labeled indications, contraindications, warnings, and precautions, the following are proven and medically necessary for hearing loss in an individual who is not a candidate for an air-conduction hearing aid: bilateral fully or partially implantable bone-anchored hearing aids for conductive or mixed hearing loss in both ears; bilateral or unilateral bone conduction hearing aids utilizing a headband or adhesive (without osseointegration); semi-implantable electromagnetic hearing aid for sensorineural hearing loss; unilateral fully or partially implantable bone-anchored hearing aids for conductive or mixed hearing loss in one or both ears; unilateral fully or partially implantable bone-anchored hearing aids for sensorineural hearing loss in one ear.

Enumerated device types considered medically necessary when FDA-indicated.

Unproven / Not medically necessary

Not medically necessary when ANY of the following apply

Unproven devices: Intraoral bone conduction hearing aids; laser or light-based hearing aids; totally implanted middle ear hearing systems are unproven and not medically necessary for treating hearing loss due to insufficient evidence of efficacy.

From Coverage Rationale and device sections.

Coverage and clinical decision criteria

Evidence-supported coverage considerations and recommended clinical approach

Trial and selection: Consider non-implantable bone conduction devices (softband, headband, ADHEAR) as an initial trial, especially in children or those unwilling or unable to undergo surgery; if trial produces audiological or quality-of-life benefit, implantation may be considered.trial shows measurable audiological and/or quality-of-life improvement

Supported by cohort studies and systematic reviews reporting functional gains and high satisfaction (see cited evidence).

Device-specific evidence: Implantable devices (partially/fully implantable, transcutaneous magnetic coupling) show audiological benefit and high patient satisfaction in observational studies and systematic reviews but evidence quality is low to very low and comparative superiority is not established.evidence varies by device

Systematic reviews and assessments note limitations (nonrandomized designs, small samples); interpret benefits with caution.

Coverage decision nodes

Device coverage contingent on meeting device-specific FDA/label criteria and documentation of expected benefit; evidence strength varies by device.

FDA-labeled device indications: Patient meets the specific FDA/label selection criteria for the requested device (age, audiometric thresholds, word recognition score, anatomy, prior hearing aid experience where recommended)see device labeling in documentation

Labeling references include Vibrant Soundbridge, Maxum, BAHA family, Sophono, Baha Attract, Bonebridge; details in respective citations

Evidence-supported devices: Devices with supportive evidence from clinical trials or FDA clearance (e.g., Earlens CHD, semi-implantable Vibrant Soundbridge, BAHA systems, Bonebridge) may be considered when labeling criteria are metclinical benefit demonstrated in cited studies but limitations exist

Monitor for device-specific adverse events and need for longer-term comparative data

Devices with insufficient evidence:

Baha Attract System indications

Baha Attract System — Covered when ALL of the following are met:

Baha Attract candidacy: Patient aged ≥5 yearsage >= 5

Per FDA clearance; see Cochlear Baha Attract labeling (BP100/BP1100).

Hearing loss type: Conductive or mixed hearing loss and able to benefit from amplification; PTA bone-conduction threshold (0.5,1,2,3 kHz) should be ≤45 dB HL for BP100 or ≤55 dB HL for BP1100.PTA BC <=45 or <=55 dB HL

Measured at 0.5, 1, 2, and 3 kHz per device labeling.

Bilateral fitting: Both ears meet above BC criteria and have symmetric thresholds (difference <10 dB average or <15 dB at individual frequencies)interaural difference <10 dB avg or <15 dB freq

Bonebridge indications

Bonebridge — Covered when ALL of the following are met:

Age: Patient aged ≥12 yearsage >= 12

Per FDA clearance for Bonebridge.

Hearing loss type: Conductive or mixed hearing loss with PTA bone-conduction threshold (0.5,1,2,3 kHz) ≤45 dB HLPTA BC <=45 dB HL

Measured at 0.5, 1, 2, and 3 kHz per device labeling.

Bilateral fitting: Symmetric BC thresholds: <10 dB average difference between ears or <15 dB at individual frequenciesinteraural difference <10 dB avg

Symmetry definition per labeling.

Osia System indications

Osia/Osia 2 System — Covered when ALL of the following are met:

Age: Patient aged ≥12 yearsage >= 12

Per FDA 510(k) clearance for Osia and Osia 2.

Hearing loss type: Conductive or mixed hearing loss with PTA bone-conduction threshold (0.5,1,2,3 kHz) ≤55 dB HLPTA BC <=55 dB HL

Measured at 0.5, 1, 2, and 3 kHz per device labeling; system fitting range ~55 dB SNHL.

Bilateral fitting: Symmetric BC thresholds: <10 dB average difference between ears or <15 dB at individual frequenciesinteraural difference <10 dB avg

Symmetry definition per labeling.

Non-implantable bone-conduction device indications

Non-implantable bone-conduction devices — Covered when ALL of the following are met (device-specific thresholds apply):

Hearing loss type: Conductive or mixed hearing loss and likely to benefit from amplificationdevice-specific PTA BC thresholds (examples: BP100 ≤45 dB HL; BP110 Power ≤55 dB HL; Cordelle II/Baha 5 SuperPower ≤65 dB HL; ADHEAR ≤25 dB HL)

Measured at 0.5, 1, 2, and 3 kHz; some devices include 4 kHz in documentation.

Bilateral fitting intended when both ears meet BC criteria and thresholds are symmetric (<10 dB average difference or <15 dB at individual frequencies)interaural difference <10 dB avg

Symmetry definitions follow device labeling.

SSD indication: Single-sided deafness with contralateral AC PTA ≤20 dB HL or inability/intolerance to use AC CROS; devices may be indicated as CROS alternativesAC PTA <=20 dB HL

Other implantable/contact device indications

Other implantable/contact devices — Covered when FDA indications are met:

Esteem totally implanted middle ear device per FDA approval; candidacy per device labeling and clinical judgmentdevice labeling

Refer to Esteem PMA documents and device labeling for selection criteria.

Earlens Contact Hearing Device indicated for adults ≥18 years with mild to severe sensorineural hearing impairment who can benefit from amplificationage >= 18; SNHL mild-severe

Per FDA 510(k) clearance and product labeling; provides amplification up to 10 kHz.

This policy addresses coverage for wearable, bone-anchored, semi-implantable and other hearing aid systems and applies nationally except where specific state policies supersede it. This Medical Policy does not apply to certain listed states that have state‑specific versions of the policy; when federal, state, or contractual benefit plan terms differ, those terms govern coverage decisions. Providers should confirm plan-specific benefit terms and applicable laws before proceeding with authorization or billing.

Devices that are no longer manufactured may be excluded from coverage because they are unavailable and the evidence base for similar devices may be limited. For example, the SoundBite™ intraoral bone conduction system ceased production after the manufacturer filed for bankruptcy, and no successor product has been introduced; such unavailability can affect coverage determinations.

The policy finds insufficient quality evidence to support intraoral bone conduction hearing aids for treatment of hearing loss. Published studies are limited by small populations, short follow-up, and lack of randomization or appropriate control groups, which undermines the evidence needed to establish efficacy.

Coverage under this policy may differ by plan or jurisdiction. Federal, state, or contractual benefit plan terms take precedence where they conflict with this Medical Policy; providers must verify and follow the specific benefit terms that apply to the member.

The policy explicitly lists device categories considered not medically necessary or unproven due to insufficient evidence of efficacy: Intraoral bone conduction hearing aids, laser or light‑based hearing aids, and totally implanted middle ear hearing systems. Requests for these device types may be denied or require substantial supporting documentation.

Because available studies of intraoral bone conduction devices are limited and of low quality, the policy treats intraoral devices as unsupported for routine coverage. Intraoral devices lacking robust comparative evidence or ongoing commercial availability are generally considered not medically necessary absent compelling individualized justification.

Summarizing the evidence assessment: the literature for intraoral bone conduction hearing aids is characterized by small case series and short follow‑up, and therefore is of insufficient quality to demonstrate clinical efficacy for treating hearing loss.

There are no additional not‑medically‑necessary conditions explicitly listed in this section beyond those identified in the policy. Providers should consult plan terms and other sections of the policy for any further exclusions or requirements.

Coding and Procedure Codes

Bone Anchored Hearing Aids (BAHA) CPTCPT

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.

Fitting, Testing, and Totally Implantable Middle Ear Implant CPTCPT

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.
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.
0953T	Totally implantable active middle ear hearing implant; revision or replacement, without mastoidectomy and replacement of sound processor.

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BAHA/SEHA/Accessory and V-codes/HCPCSmixed

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.
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.

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Wearable Hearing Aids V-codes (partial)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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Miscellaneous/unspecified V-codesHCPCS

V5267	Hearing Aid or assistive listening device/supplies/accessories, not otherwise specified.
V5298	Hearing aid, not otherwise classified.

Applicable CPT code additionsCPT

0951T	added CPT code (per Policy History)
0952T	added CPT code (per Policy History)
0953T	added CPT code (per Policy History)
0954T	added CPT code (per Policy History)
0955T	added CPT code (per Policy History)

Degree of hearing loss categories (dBHL) - inv-25

Normal-10 to 15 dBHL

Slight16 to 25 dBHL

Mild26 to 40 dBHL

Moderate41 to 55 dBHL

Moderately severe56 to 70 dBHL

Severe71 to 90 dBHL

Profound91 dBHL or more

Pure Tone Average (PTA) and Bone Conduction thresholds — examples and device-dependent thresholds - inv-26

Example device-level BC PTA threshold (Baha Attract BP100)BC PTA ≤45 dB HL (measured at 0.5, 1, 2, and 3 kHz)

Example device-level BC PTA threshold (Baha Attract BP1100)BC PTA ≤55 dB HL (measured at 0.5, 1, 2, and 3 kHz)

Bonebridge examplePTA BC ≤45 dB HL (measured at 0.5, 1, 2, and 3 kHz)

ADHEAR (non-implantable) examplePTA BC ≤25 dB HL (measured at 0.5, 1, 2, and 3 kHz)

General noteDevice-specific PTA/BC or AC thresholds vary by manufacturer and are measured at specified frequencies (commonly 0.5, 1, 2, and 3 kHz)

Pure tone average (PTA) bone-conduction or air-conduction thresholds — device-specific examples - inv-27

BP100 / Baha 4 / Baha 5 (non-implantable/softband)PTA BC ≤45 dB HL (0.5,1,2,3 kHz) for BP100/Baha 4/Baha 5 processors

BP110 Power / Baha 5 PowerPTA BC ≤55 dB HL (0.5,1,2,3 kHz) for BP110 Power and Baha 5 Power processors

Cordelle II / Baha 5 SuperPowerPTA BC ≤65 dB HL (0.5,1,2,3 kHz) for Cordelle II and Baha 5 SuperPower

Bonebridge / Sophono / Otomag examplesPTA BC ≤45 dB HL (measured at 0.5,1,2,3 kHz); bilateral fitting when symmetric thresholds

Provider Requirements, Prior Authorization, and Documentation

Note

Procedure codes listed for review

Certain surgical implantation, replacement, fitting, and testing procedure codes are listed in the policy and may require benefit determination or review prior to reimbursement.

Examples include CPT codes 69710, 69714, 69716, 69717, 69719, 69729, 69730 for BAHA implantation/replacement.
Fitting/testing codes such as 92590–92595 and totally implantable implant codes 0951T–0955T are listed for reference.

Prior Authorization

Prior authorization recommended for implantable/novel devices

Prior authorization is recommended for implantable and novel devices to ensure device indication and adequate supporting evidence are documented before proceeding.

Applies to totally implantable middle ear systems, Bonebridge, and other implanted bone conduction systems with variable evidence.

Prior Authorization

Confirm FDA labeling criteria

Prior authorization should confirm that the patient meets the specific FDA/label selection criteria for the requested implanted or semi‑implanted device (age, PTA/BC thresholds, word recognition scores, symmetry, and other labeling requirements).

Examples: Baha Attract age ≥5 and device‑specific BC PTA thresholds; Bonebridge age ≥12 and BC PTA ≤45 dB HL; Osia age ≥12 and BC PTA ≤55 dB HL.

Billing Rule

Procedure code updates and authorization

The policy was updated to add CPT codes 0951T–0955T; providers should follow this policy and plan‑specific procedures (including prior authorization where applicable) when billing these new codes.

Newly added totally implantable active middle ear hearing implant codes: 0951T, 0952T, 0953T, 0954T, 0955T.

Step Therapy

Trial with non-implantable bone conduction devices

A headband or adhesive non‑implantable bone conduction device may be used as a trial to determine potential benefit prior to surgical implantation, and as a temporary option in children until bone maturation permits implantation.

Used in adults to assess likely benefit from an implanted system and in children until temporal bone is mature enough for implantation.

Step Therapy

Trial of non-implantable BCDs before implantation

The literature supports trialing non‑surgical bone conduction options (softband, headband, ADHEAR) as an initial intervention in children and some adults prior to considering implantation.

Multiple cohort and comparative studies report audiological benefit and high satisfaction with non‑implantable trials.

Documentation Required

Conservative therapy documentation

For active middle ear implants and bone conduction devices, consider documenting a trial and measurable benefit with appropriately fitted conventional air‑conduction or bone‑conduction hearing aids where labeling or specialty statements recommend prior experience.

AAO‑HNS guidance and device labeling recommend prior experience with appropriately fitted hearing aids for selected devices.

Step Therapy

Recommendation for trial with conventional hearing aids

Prior experience with appropriately fitted air‑conduction or bone‑conduction hearing aids is recommended before receiving certain implantable devices (e.g., Bonebridge, Osia, Baha systems).

Device labeling for Bonebridge and Osia specifically recommends prior hearing‑aid experience; Baha labeling includes indications and prior aid considerations.

Documentation Required

Documentation referenced

Medical records documentation used for reviews is referenced in the Table of Contents and should be provided for prior authorization and coverage review.

See 'Medical Records Documentation Used for Reviews' entry in the Table of Contents.

Documentation Required

Suggested supporting documentation for intraoral devices

When proposing intraoral devices, include reported clinical outcome measures such as APHAB scores, single‑sided deafness questionnaires, and baseline and follow‑up audiometric testing to support medical necessity.

Gurgel et al. reported APHAB and SSD questionnaires plus audiometric testing at 6 and 12 months in SoundBite studies.

Documentation Required

Device-specific FDA indication documentation

Include device‑specific FDA indication documentation in prior authorization submissions: age limits, pure tone average bone‑conduction/air‑conduction thresholds, word recognition scores, and interaural symmetry as specified in labeling.

Examples: Baha Attract age ≥5 and BC PTA thresholds; Bonebridge age ≥12 and BC PTA ≤45 dB HL; Vibrant Soundbridge word recognition ≥50%.

Documentation Required

Required audiometric thresholds per device

Device‑specific audiometric measurements required by FDA labeling—such as pure tone average bone‑conduction (BC) and air‑conduction (AC) thresholds measured at 0.5, 1, 2, and 3 kHz—must be documented to determine eligibility for each device.

Labeling lists BC PTA thresholds (examples: BP100 ≤45 dB HL; BP110 Power ≤55 dB HL; ADHEAR ≤25 dB HL) and AC PTA thresholds for SSD candidacy (≤20 dB HL).

Denial Risk

Coding inclusion not guarantee of coverage

Listing a procedure or supply code in the policy does not imply the service described by that code is covered; benefit coverage is determined by federal, state, or contractual requirements and applicable laws.

Inclusion of a code does not guarantee reimbursement or claim payment; other policies and plan terms may apply.

Denial Risk

Intraoral device evidence limitation

Use of intraoral bone conduction hearing aids (for example, SoundBite) is limited by insufficient high‑quality evidence and device unavailability; lack of robust evidence or manufacturer support may trigger coverage denial or require substantial justification.

SoundBite is no longer manufactured (bankruptcy noted) and studies are small, uncontrolled, and of low quality.

Denial Risk

Evidence-based denial risk

Requests for intraoral bone conduction devices or totally implanted middle ear systems may be at higher risk for denial or medical‑necessity review because evidence is insufficient in quality and lacks controlled comparative trials.

Totally implanted middle ear systems and intraoral devices are described in the policy as having insufficient quality evidence and study limitations.

Note

Plan terms govern coverage

Coverage decisions must follow the applicable federal, state, or contractual benefit plan terms; in the event of a conflict, those requirements govern coverage determination.

This policy is informational and plan‑specific terms may differ or govern final coverage decisions.

Definitions and Key Terms

Degree of Hearing Loss — categories and dBHL ranges - inv-45

Normal-10 to 15 dBHL

Slight16 to 25 dBHL

Mild26 to 40 dBHL

Moderate41 to 55 dBHL

Moderately severe56 to 70 dBHL

Severe71 to 90 dBHL

Mixed Hearing Loss — definition - inv-46

DefinitionA mixed hearing loss occurs when conductive hearing loss coexists with sensorineural hearing loss, indicating damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

ImplicationMay require combined assessment of air- and bone-conduction thresholds to determine appropriate device candidacy

MeasurementIdentified by elevated air-conduction thresholds with bone-conduction thresholds indicating sensorineural component

Bone-anchored Hearing Aids (BAHA/BCHA) — definition - inv-47

DefinitionSurgically implantable systems that convert sound into mechanical vibrations conducted via the skull to the inner ear; include percutaneous (abutment) and transcutaneous (magnetic coupling) systems.

ExamplesBAHA Attract, Bonebridge, Osia, percutaneous BAHA systems (Branemark/Baha)

ClassificationClassified by the FDA as Hearing Aids

Semi-Implantable Electromagnetic Hearing Aids (SEHA) — definition - inv-48

DefinitionDevices with a surgically implanted magnetic component in the middle ear driven by an external sound processor that transmits amplified electrical signals to produce ossicular vibration and enhanced sound perception.

MechanismExternal processor converts sound to electrical signals sent to implanted magnet/drive to vibrate ossicles

ExamplesVibrant Soundbridge, Maxum (formerly Soundtec Direct), MET Ossicular Stimulator

Intraoral bone conduction hearing aid (IOBC) — definition and example - inv-49

DefinitionA non-surgical system using an oral retainer transducer to transmit sound via the teeth and skull to the cochleae, bypassing the outer and middle ear.

ExampleSoundBite Hearing System (manufacturer Sonitus Medical; production ceased after bankruptcy)

Typical indicationDeveloped for individuals with single-sided deafness (SSD)

Laser/light-based hearing device — definition (e.g., Earlens CHD) - inv-50

DefinitionA system that uses a behind-the-ear light-based processor and a tympanic membrane transducer to convert infrared light pulses into mechanical vibrations applied to the tympanic membrane.

ExampleEarlens Contact Hearing Device (CHD)

IndicationFDA-cleared for adults ≥18 years with mild to severe sensorineural hearing impairment

Totally/partially/fully implantable middle ear or bone conduction systems — definition - inv-51

DefinitionDevices implanted wholly or partially within the body that deliver mechanical or electrical signals to the middle or inner ear; includes totally implantable, partially implantable, and transcutaneous magnetic coupling systems.

ExamplesEsteem (totally implantable), Carina (developmental), Bonebridge (partially implantable), Osia (implantable bone conduction)

ConsiderationCandidacy and coverage require meeting device-specific FDA labeling and evidence review

Single-sided deafness (SSD) — definition and referenced normal-hearing criteria - inv-52

DefinitionUnilateral sensorineural deafness in one ear with normal hearing in the contralateral ear; SSD candidacy defined by device labeling criteria for the contralateral ear.

Referenced normal-hearing criteriaNormal hearing defined as PTA air-conduction threshold of better than or equal to 20 dB HL (measured at 0.5, 1, 2, and 3 kHz)

Use caseDevices may be indicated as an alternative to AC CROS when the patient cannot or will not use AC CROS

Symmetrical bone-conduction thresholds — definition - inv-53

DefinitionSymmetry of bone-conduction thresholds between ears, typically required for bilateral fittings and device candidacy.

Labeling criterionDefined as less than a 10 dB average difference between ears (measured at 0.5, 1, 2, and 3 kHz) or less than a 15 dB difference at individual frequencies

Clinical implicationUsed to determine suitability for bilateral implantation or bilateral non-implantable fittings

Symmetrical bone-conductive thresholds — numeric definition - inv-54

Numeric definition (average)Less than a 10 dB average difference between ears measured at 0.5, 1, 2, and 3 kHz

Numeric definition (individual frequencies)Less than a 15 dB difference at individual frequencies

Measurement noteSome labeling may reference 4 kHz instead of 3 kHz for averaging; follow device-specific instructions

Normal hearing (for SSD candidacy) — definition (PTA AC ≤20 dB HL) - inv-55

DefinitionNormal hearing for SSD candidacy is defined as a pure tone average (air-conduction) threshold of better than or equal to 20 dB HL measured at 0.5, 1, 2, and 3 kHz.

Use in labelingReferenced in FDA indications for Baha Attract, Bonebridge, ADHEAR and similar devices for SSD candidacy

Measurement guidanceConfirm PTA AC in the contralateral ear at specified frequencies per device labeling

OpenPayer

Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable

Coverage Criteria and Device-specific Indications

Coding and Procedure Codes

Provider Requirements, Prior Authorization, and Documentation

Background and Scope

Definitions and Key Terms