CurrentUnitedHealthcarePolicy CS052TN.T

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

Policy governing coverage and medical necessity criteria for wearable, bone-anchored, semi-implantable, and related hearing aids/devices for TennCare Medicaid and CoverKids in Tennessee; applies only to individuals under 21 years of age.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052TN.T

Change TypeClarification & updates (definitions, codes, evidence sections)

Effective DateJun 1, 2026

Next Review Date

Key ActionEnsure the patient's medical record contains legible documentation (history, exam, diagnostic test results, audiometric thresholds and WRS) to support medical necessity and make records available upon request.

SourceLink

POLICY UPDATE CHANGES

Added language specifying that benefit coverage is determined by federal, state, or contractual requirements and applicable laws which may require coverage for a specific service.

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).

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect most current information.

Under 21Eligible Age Population

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.

Policy Codes Mentioned

MixedEvidence strength

MultipleFDA-cleared device types referenced

Coverage Summary

Scope: This policy governs coverage and medical necessity criteria for wearable, bone-anchored, semi-implantable, and related hearing aids and devices for TennCare Medicaid and CoverKids in Tennessee and applies only to individuals under 21 years of age.

Stance (high level): Wearable air conduction hearing aids (ACHAs) are the standard, proven, and medically necessary treatment when indicated. When ACHAs are not possible or appropriate, FDA-labeled implantable and nonimplantable alternatives (including bone-anchored devices, semi-implantable electromagnetic middle-ear devices, and nonimplantable bone conduction systems using headbands/adhesives or softbands) are covered if device-specific and FDA/clinical criteria are met. Certain device categories (notably intraoral bone conduction devices, laser/light-based devices, and totally implanted middle-ear systems) are identified as unproven and not medically necessary due to insufficient or conflicting evidence.

Evidence summary: The evidence base is mixed: systematic reviews, cohort studies, and device clearances support benefit for many bone-conduction and semi-implantable devices in selected indications, but study quality varies and randomized trials are limited. Multiple device types and models are discussed in the policy and FDA sections.

Eligible Age PopulationUnder 21

Headline PTA thresholds summaryDevice-specific PTA thresholds include: ADHEAR ≤25 dB BC; BP100/Baha4/Baha5 ≤45 dB BC; BP110/Baha5 Power ≤55 dB BC; Cordelle II/Baha5 SuperPower ≤65 dB BC; Otomag Alpha1 <45 dB BC; Osia ≤55 dB BC; BONEBRIDGE ≤45 dB BC

Devices listed as Not Medically Necessary3

Evidence strengthMixed

Medical-Necessity Criteria

General Coverage / Medical Necessity

Covered when ALL of the following are met:

ALL of the following

Member is under 21 years of age (TennCare Medicaid / CoverKids).
Wearable air conduction hearing aids required for correction of a hearing impairment.

Alternative Devices When Not Candidate for Air Conduction Hearing Aid

When not a candidate for an air conduction Hearing Aid and used according to FDA labeling, the following are proven and medically necessary:

ONE of

Bilateral fully or partially implantable bone-anchored Hearing Aids for Conductive or Mixed Hearing Loss in both ears.

FDA Indications and Selection Criteria (by device)

FDA Indications and Selection Criteria (by device type)

Device-specific FDA indications, selection criteria, model notes and approval dates (by device):

Vibrant Soundbridge

MAXUM Hearing Implant

BAHA System (general)

BAHA bilateral criteria: Moderate to severe bilateral symmetrical conductive or mixed hearing loss; <10 dB average or <15 dB in bone conduction thresholds at 500,1000,2000,4000 Hz; average bone conduction thresholds better than 45 dB HL.symmetry <10 dB avg or <15 dB at frequencies; BC avg <=45 dB HL

BAHA for SSD/unilateral SNHL: Unilateral sensorineural deafness in one ear with normal hearing in the other ear (PTA AC <=20 dB at 0.5,1,2,3 kHz); option when AC CROS cannot/will not be used.<=20 dB HL (0.5,1,2,3 kHz)

Coding

Wearable Hearing Aid Supply Codes (V-codes)HCPCSCovered

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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1/5

BAHA / Implantation 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.

Totally Implantable Middle Ear CPT (unlisted / procedure codes)CPT

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.
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 / Implantable Device Supply HCPCS (L-codes)HCPCS

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.

Semi-Implantable / Middle Ear HCPCS / CPTmixed

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

FDA clearance / device model references (informational)mixed

K984162	Branemark/BAHA System clearance (reference PMN)
K090720	BAHA BP100 clearance
K081606	BAHA Intenso (2008) reference
K042017	BAHA Divino (2004) reference
K100360	BA31300 implant / BA300 abutment (2010) reference
K082108	OBC Bone Anchored Hearing Aid System (Oticon Medical) 2008
K121228	Ponto Bone Anchored Hearing System (Oticon Medical) 2012
K211640	Ponto 5 Mini clearance (2021)
K102199	Otomag/Sophono clearance reference
K153391	Otomag related clearance reference

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Applicable CPT/HCPCS codes removed from policymixed

92590	Fitting and testing of hearing aids; separate listing
92591	Speech audiometry
92592	Hearing aid checks
92593	Speech recognition
92594	Real-ear measurement
92595	Hearing aid fitting
S0618	Hearing aid battery supply/related
V5010	Dispensing hearing aid, unilateral, programmable
V5011	Dispensing hearing aid, bilateral, programmable
V5014	Dispensing hearing aid, external, monaural

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1/2

Provider Actions

Documentation Required

Medical Records Documentation Required

Patient medical records must fully support medical necessity for requested hearing devices. Documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests; records must be legible and made available upon request.

Relevant medical history (hearing complaints, onset, prior treatments)
Physical exam findings (otoscopy, middle-ear status)
Pertinent diagnostic test results (audiograms, PTA, WRS, tympanometry)
Records must be legible and available upon request

Prior Authorization

Equipment Upgrades Treated as New Service

Equipment upgrades are processed and reviewed the same as a new service. Upgrades require meeting the same clinical criteria as new requests and therefore may be subject to prior review or authorization procedures.

Background & Evidence

This policy applies to Tennessee Medicaid (TennCare) and CoverKids and is restricted to beneficiaries under 21 years of age.

Rationale: Wearable air conduction hearing aids (ACHAs) are the standard treatment for hearing loss that cannot be corrected medically or surgically. When ACHAs are not possible or appropriate, the policy outlines covered alternatives — including fully or partially implantable bone-anchored systems, nonimplantable bone conduction devices (headband/adhesive/softband), and semi-implantable electromagnetic middle-ear hearing aids — when used according to FDA labeling and clinical criteria.

The policy also notes that some device categories are considered unproven and not medically necessary due to insufficient evidence (examples include intraoral bone conduction devices, laser/light-based hearing aids, and totally implanted middle-ear systems).

Operational note: Benefit coverage is determined by federal, state, or contractual requirements and applicable laws; medical records documentation may be required to demonstrate medical necessity (relevant history, physical exam, and diagnostic test results must be legible and available upon request).

Evidence	Finding/Value
Cochrane review (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 (review of 5 RCTs, 825 individuals).
Multiple systematic reviews and cohort studies
Support benefits of bone conduction devices, semi-implantable devices, and active transcutaneous implants for conductive/mixed loss and SSD; evidence quality varies with lack of RCTs.
pTCBI PTA gain (weighted mean)
28.4 ±2.1 dB (weighted mean PTA gain for passive transcutaneous bone conduction implants).
pTCBI SRT gain (mean)
32.9 ±3.9 dB (mean SRT gain reported for pTCBIs).
SRT/functional gain (Earlens - Gantz 2017)
Mean functional gain 31 dB across 2–10 kHz; word recognition improved by 35% (rAU) in pivotal trial supporting FDA clearance.
Carina fully implantable middle-ear implant (Peixoto 2019/2023)
Auditory gain 15–20 dB at 1 year (greater improvements in mixed hearing loss); improved speech recognition in mixed-loss subgroup.
Esteem totally implanted middle-ear device adverse effects (Klein et al. systematic review)
Chorda tympani/taste disturbance ~30%; facial weakness ~8%; multiple explants/revisions reported; safety concerns and limited-quality evidence.
FDA references / device clearances
Numerous device-specific FDA 510(k)/PMA clearances and de novo decisions cited for Vibrant Soundbridge, MAXUM, BAHA/Baha systems, BONEBRIDGE, Osia, Earlens, Esteem, etc.; professional labeling provides selection criteria and thresholds.
Professional guidance (AAO-HNS, ASHA)
AAO-HNS considers active middle-ear implants and bone conduction hearing devices appropriate for selected adults; professional statements and ASHA resources referenced.

Definitions

Definitions:

Conductive Hearing Loss: Sound not conducted efficiently through outer ear canal to eardrum and ossicles; often correctable medically or surgically (ASHA).

Revision History

06/01/2026material_changeLatest

Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and applicable laws and that medical records documentation may be required to assess whether the member meets clinical criteria; medical record must fully support medical necessity (relevant history, physical exam, diagnostic test results), be legible, and made available upon request.

06/01/2026revised_definition

Updated definition of 'Conductive Hearing Loss' (Definitions section updated).

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS052TN.T

Change TypeClarification & updates (definitions, codes, evidence sections)

Effective DateJun 1, 2026

Next Review Date

SourceLink

On This Page

Bilateral or unilateral bone conduction Hearing Aids using 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.

Equipment Upgrades

Operational rules for upgrades:

ALL of the following

A change in the member's medical condition and equipment needs requires the same criteria as a new request.
Equipment upgrades are treated as equivalent to a new service.

Nonimplantable Bone Conduction Hearing Aids (general FDA-cleared indications by device)

Covered when ALL of the following device-specific FDA-cleared criteria are met:

ALL of the following

Device-specific PTA bone conduction threshold requirements (ONE of)
- For BP100, Baha 4, and Baha 5 sound processors: PTA bone conduction hearing threshold (0.5, 1, 2, 3 kHz) should be better than or equal to 45 dB HL.<=45 dB HL (0.5,1,2,3 kHz)
- For BP110 Power and Baha 5 Power sound processors: PTA bone conduction hearing threshold (0.5, 1, 2, 3 kHz) should be better than or equal to 55 dB HL.<=55 dB HL (0.5,1,2,3 kHz)
- For Cordelle II and Baha 5 SuperPower sound processors: PTA bone conduction hearing threshold (0.5, 1, 2, 3 kHz) should be better than or equal to 65 dB HL.<=65 dB HL (0.5,1,2,3 kHz)
- For Otomag Alpha 1(S): PTA bone conduction threshold for the indicated ear should be better than 45 dB HL (0.5,1,2,3 kHz).<45 dB HL (0.5,1,2,3 kHz)
- For ADHEAR system: PTA bone conduction hearing threshold (0.5,1,2,3 kHz) should be better than or equal to 25 dB HL.<=25 dB HL (0.5,1,2,3 kHz)
Indication categories (ONE of)
- Conductive or mixed hearing loss in patients of any age who can benefit from sound amplification.
- Bilateral fitting for patients who meet the device threshold criteria in both ears with bilaterally symmetric moderate to severe conductive or mixed hearing loss.symmetry: <10 dB average or <15 dB at individual frequencies
- Single-sided deafness (SSD): unilateral sensorineural deafness in one ear with normal hearing in the other ear (PTA air conduction threshold 0.5,1,2,3 kHz better than or equal to 20 dB HL).<=20 dB HL (0.5,1,2,3 kHz)
- Patients indicated for an air conduction CROS hearing aid but cannot or will not use an air conduction CROS.
- Otomag: patients with profound SNHL in one ear and normal hearing in the opposite ear who cannot use an AC CROS (hearing ear PTA air conduction threshold better than 20 dB HL; symmetry criteria: average difference <10 dB across frequencies or <15 dB at individual frequencies).
Device application: sound processors can be used with softband/headband (no implantation); Baha Softband cleared for use in children younger than 5 years (BP/Baha series).

Not Medically Necessary / Unproven

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

ANY of the following

Intraoral bone conduction Hearing Aids.
Laser or light-based Hearing Aids.
Totally implanted middle-ear hearing systems.

Otomag Alpha 1 (Sophono): PTA BC for indicated ear better than 45 dB HL (0.5,1,2,3 kHz); bilateral fitting applicable for symmetric losses (difference <10 dB avg or <15 dB individual); SSD/AC CROS criteria apply.<45 dB HL (0.5,1,2,3 kHz)

Cochlear Baha Attract: Patients aged >=5 years; PTA BC <=45 dB HL for BP100 and <=55 dB HL for BP1100 (0.5,1,2,3 kHz); bilateral fitting and SSD criteria as above.<=45 dB HL (BP100) ; <=55 dB HL (BP110)

BONEBRIDGE: Patients >=12 years; PTA BC <=45 dB HL (0.5,1,2,3 kHz); bilateral fitting symmetry criteria; SSD PTA AC <=20 dB HL; recommend prior experience with appropriately fit ACHAs or BCHAs.<=45 dB HL (0.5,1,2,3 kHz)

Osia System / Osia 2: Patients >=12 years; PTA BC <=55 dB HL (0.5,1,2,3 kHz); bilateral fitting symmetry criteria; SSD PTA AC <=20 dB HL; prior experience with appropriately fitted ACHAs/BCHAs recommended.<=55 dB HL (0.5,1,2,3 kHz)

Nonimplantable Baha SoundBand / Softband / SoundArc: Patients of any age for SoundBand/SoundArc; Baha osseointegrated implant system for ages >=5; PTA BC thresholds depend on processor model (e.g., <=45 dB HL for BP100/Baha4/Baha5; <=55 dB HL for BP110 Power/Baha5 Power; <=65 dB HL for Cordelle II/Baha5 SuperPower); bilateral fitting symmetry criteria; SSD PTA AC <=20 dB HL.varies by processor (<=45/55/65 dB HL)

Vibrant and MAXUM FDA approval dates (informational): Vibrant Soundbridge FDA approval: August 31, 2000; MAXUM Hearing Implant FDA approval: September 7, 2001.

Totally Implanted Middle-Ear Hearing System (Esteem)

Totally implanted middle-ear hearing system (Esteem):

Esteem prosthetic hearing restoration device is FDA-approved (PMA P090018) — covered when FDA indications and any applicable clinical criteria are met (no additional coverage criteria provided in this part).

Intraoral Bone Conduction Hearing Aid

Intraoral Bone Conduction Hearing Aid status:

No currently FDA-approved intraoral bone conduction hearing aids; SoundBite was cleared in 2011 but Sonitus Medical ceased manufacturing in 2015 and the device is not available.

Laser or Light-Based Contact Hearing Aid (Earlens)

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

Earlens Contact Hearing Device cleared April 2016 (510(k)) for individuals aged 18 years or older with mild to severe sensorineural hearing impairment who can benefit from amplification (125 Hz to 10,000 Hz).

Upgrades require the same clinical criteria as initial requests
Equipment upgrades are treated as equivalent to a new service (may trigger prior review/authorization)

Documentation Required

Adhere to device-specific FDA labeling audiometric criteria

Follow device-specific FDA professional labeling when documenting candidacy. Include pure-tone average thresholds at the specified frequencies, Word Recognition Score, patient age, and prior hearing-aid experience where applicable.

Document PTA or pure-tone thresholds at device-specified frequencies (e.g., Vibrant Soundbridge frequency ranges specified in labeling)
Record Word Recognition Score (WRS) as required by device labeling
Document patient age per device indication (e.g., adults ≥18 for some implants)
Note prior hearing-aid experience when required by labeling

Documentation Required

Consider prior use of appropriately fitted hearing aids

For devices that recommend prior hearing-aid experience, document a trial or history of appropriately fitted air conduction or bone conduction hearing aids before implantation.

Record duration and type of prior hearing-aid use (air conduction or bone conduction)
Document that prior devices were appropriately fitted
Include outcomes of prior trials (audiometric benefit, tolerability)

Documentation Required

Assess symmetry for bilateral fitting

When assessing bilateral fitting candidacy, document interaural symmetry using bone conduction thresholds. Required thresholds: average interaural difference <10 dB (specified frequencies) or <15 dB at individual frequencies.

Calculate average interaural bone conduction difference across specified frequencies (typically 0.5, 1, 2, 3 or 4 kHz)
Document that average difference is <10 dB or that differences at individual frequencies are <15 dB
Include bone conduction PTA values for each ear

Documentation Required

Medical records documentation required for review

Medical records may be requested to verify that clinical criteria are met. Records must fully support medical necessity (relevant history, physical exam, diagnostic test results), be legible, and be available upon request.

Ensure documentation clearly links findings to requested service
Maintain legible records and make them available if requested

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

Mixed Hearing Loss: Combination of conductive and sensorineural hearing loss.

Hearing Aids: Sound-amplifying devices designed to aid people with hearing impairment; includes semi-implantable electromagnetic and bone-anchored devices per FDA classification.

SSD: Single-sided deafness (unilateral sensorineural deafness with normal hearing in the contralateral ear).

PTA: Pure-tone average (commonly average of thresholds at specified frequencies).

WRS: Word Recognition Score.

SRT: Speech Recognition Threshold.

PTA (0.5,1,2,3 kHz): Pure-tone average measured at 0.5, 1, 2, and 3 kHz (or 4 kHz when specified).

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.

archived_policy_version

Archived previous policy version CS052TN.S.

revised_sections

Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect most current information.

<=20 dB HL (0.5,1,2,3 kHz); symmetry <10 dB avg or <15 dB at individual frequencies

ADHEAR: unilateral or bilateral conductive hearing loss (chronic or temporary) or SSD with normal hearing contralateral (normal defined as PTA air conduction 0.5,1,2,3 kHz <= 20 dB HL).<=20 dB HL (0.5,1,2,3 kHz)