Hearing impairment is a reduction in the ability to perceive sound. Hearing impairments can vary from slight to profound and are generally classified as conductive hearing loss, sensorineural hearing loss or mixed hearing loss.

Hearing Aids

Prescribed United States Food and Drug Administration (U.S. FDA)-approved hearing aids are eligible for payment (per the U.S. FDA, hearing aids marketed for use by the general public should have U.S. FDA approval). Any hearing aid that is not U.S. FDA approved will be denied as non-covered.

Assistive Listening Devices

Assistive listening devices are used to improve speech intelligibility by reducing the degrading effects of distance and background noise. These devices are functionally similar to a personal sound amplifier system. These devices do not replace the function of the middle ear, cochlea or auditory nerve.  Therefore, they are not considered as prosthetic devices and are non-covered.

Bone Conduction Implants

Bone anchored hearing devices (BAHA), unilateral or bilateral, full or partial, indicated for conductive, mixed hearing loss, or unilateral deafness hearing loss may be considered medically necessary as prosthetic devices when at least ONE of the following criteria are met:

• Congenital or surgically induced malformation (e.g., atresia) of the external ear, ear canal, or middle ear, or
• Infection of the ear canal resulting in chronic draining ears, or
• Fixation of the ossicles (middle ear bones), or
• Single sided deafness (SSD) (allow stimulation of the functioning cochlea) due to:
  • Viral infections(CMV, HSV, measles, or others); or
  • Meniere’s Disease; or
  • Trauma; or
  • Sudden deafness; or
  • Acoustic neuroma; or
  • Individual who is indicated for an air conduction contralateral routing of signals (AC CROS) hearing aid, but who for some reason cannot or will not use an AC CROS; or
• Individuals who cannot wear conventional hearing aids for ONE or the following reasons:
  • Tumors of the ear canal or tympanic cavity; or
  • Dermatitis of the external ear canal; or
  • Severe chronic otitis or otitis media; or
  • Sensitivity to ear molds.

There MUST be a functioning cochlea or cranial nerve VIII for the BAHA to work and ALL the following audiological criteria must be met:

• Individual is age five (5) years or older;
• A pure tone average (PTA)  bone-conduction threshold measured at 0.5, 1, 2, and 3 kHz of better than or equal to 45 dB (OBC and BP100 devices), 55 dB (Intenso device) or 65 dB (Cordele II device).
• As an alternative to an air-conduction CROS hearing aid in individuals five (5) years of age and older with single-sided sensorineural deafness and normal hearing in the other ear; and the pure tone average air conduction threshold of the normal ear should be better than 20 dB measured at 0.5, 1, 2, and 3 kHz.

For bilateral implantation, individuals should meet the above audiologic criteria, and have a symmetrically conductive or mixed hearing loss as defined by a difference between left and right side bone conduction threshold of less than 10 dB on average measured at 0.5, 1, 2 and 3 kHz, or less than 15 dB at individual frequencies.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Processor replacement may be considered medically necessary two (2) per five (5) years. Processor replacement greater than two (2) per five (5) years will be denied as not medically necessary. 

Quantity level limits or quantity of supplies that exceed the frequency guidelines listed on the policy will be denied as not medically necessary.BAHA for any other indication than listed above is considered not medically necessary.

BAHA not meeting the criteria as indicated in this policy is considered not medically necessary.

Auditory Brainstem Implant

Unilateral use of an auditory brainstem implant (using surface electrodes on the cochlear nuclei) may be considered medically necessary in individuals when ALL the following criteria have been met:

• Neurofibromatosis type II; and
• 12 years of age or older; and
• Are rendered deaf due to bilateral resection of neurofibromas of the auditory nerve.

An auditory brainstem implant not meeting the criteria as indicated in this policy, indlucing non-neurofibromatosis type 2 indications is considered experimental/investigational, and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. 

Bilateral use of an auditory brainstem implant is considered experimental/investigational, and, therefore, non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

One (1) headband per year may be considered medically necessary. More than one (1) headband per year will be denied as not medically necessary.

Processor replacement may be considered medically necessary two (2) per five (5) years. Processor replacement greater than two (2) per five (5) years will be denied as not medically necessary. 

Quantity level limits or quantity of supplies that exceed the frequency guidelines listed on the policy will be denied as not medically necessary.

Audiological Testing

Audiological testing is eligible as a diagnostic procedure, when not screening in nature.

Audiological testing performed without a physician evaluation and an order for the testing prior to testing are deemed to be screening in nature, and is considered not medically necessary.

Aural Rehabilitation

An audiologist performs the primary evaluation of the status of an aural rehabilitation program under the direction of physicians or speech-language pathologists within their scope of practice.

The speech-language pathologist is typically responsible for evaluating the individual's receptive and expressive communication skills and providing the services to anchor improvement.

Aural rehabilitation not meeting the criteria as indicated in this policy is considered not medically necessary