Coverage for hearing aids, and middle ear implants is determined according to individual or group customer benefits. The patient’s hearing aid benefit would be reviewed for details on examination, referral, and hearing aid dealer requirements.

Traditional Hearing Aids
Prescribed FDA-approved hearing aids are eligible for payment (per the FDA, hearing aids marketed for use by the general public should have FDA approval). However, the prescription for the hearing aid must accompany all claims submitted by hearing aid dealers/fitters. If the prescription is not submitted with the claim, the claim must be developed for that information.

Hearing aids should be reported with the code that most accurately describes the hearing aid selected. Use codes (V5030-V5080, V5100, V5120-V5150, V5170-V5190, V5210-V5230, V5242-V5263, V5298, V5299) as appropriate.

Middle Ear Implant
Procedure code S2230 should be used to report the implantation of a semi-implantable middle ear hearing prosthesis.

Hearing implants and middle ear devices are classified as “hearing aids”. Only when specifically requested by a group can the surgical implantation/removal of an implanted hearing device be identified as eligible within the group’s surgical benefit (since the hearing aid benefit is not intended to cover a surgical procedure).

When hearing impairment, as determined by a licensed physician, is of such magnitude as to require amplification, the patient’s medical record should support the medical necessity for amplification.

Audiological Testing
Audiological testing performed without a physician evaluation and an order for the testing prior to testing are deemed to be screening in nature, and as such, is not covered. Hearing screening should be reported with procedure code V5008.

Audiological testing is eligible and should be reported under procedure codes 92551-92588 and 92620-92621, as appropriate. Please note that all of these services represent bilateral testing.

NOTE:

Refer to Medical Policy Bulletin M-8 for guidelines on tympanometry and acoustic reflex testing.

Description

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 are instruments that amplify sound for individuals who are unable to hear well. Prior to determining treatment options, an audiological evaluation should be completed to determine the severity of the hearing loss as well as to determine the most appropriate treatment for the specific patient.

The following devices and procedures are available for treating these types of hearing loss:

Traditional Hearing Aids
Traditional hearing aids are externally worn microphones that amplify sound which is then directed to the ear through an ear mold that fits in the ear canal. These hearing aids can be defined as monaural, binaural, programmable, non-programmable, analog and digital.

Middle Ear Implant
Middle ear implants (MEI) (e.g., Vibrant Soundbridge, The Direct System) are designed for individuals with moderate to severe sensorineural hearing loss who are dissatisfied with the limitations of conventional hearing aids. These devices, either implantable or semi-implantable, directly vibrate the ossicles of the inner ear to produce sound.

Audiological Testing
Hearing loss can result from injury or disease of any part of the auditory system (e.g., foreign objects, growths, perforation). The type of hearing loss refers to the site of the lesion or pathology. Audiological testing reveals the degree and type of hearing loss.

Conductive hearing loss results from impairment of sound transmission through the external or middle ear since these parts conduct mechanical vibrations to the inner ear or sensorineural system. Such loss may result from a perforated tympanic membrane, accumulation of pus, serous fluid in the middle ear (as in otitis media), or impaired ossicular mobility. In audiometric testing, a conductive loss is associated with better conduction thresholds in bone than in air, since bone conducted sound does not pass through the external or middle ear; whereas air conducted sound does.

Sensorineural hearing loss indicates a lesion in the inner ear, the eighth cranial nerve, or higher neural pathways. This type of hearing loss may result from Meniere's disease, viral labyrinthitis, tumors, multiple sclerosis or noise induced hearing loss.

Mixed hearing loss results from a combined sensorineural-conductive dysfunction.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Routine hearing tests (except as indicated under preventive care, children), hearing aids, (including implanted bone conduction hearing aids) and testing and examinations for the prescribing or fitting of hearing aids are not covered for FEP.

MPRM 7.01.03, 07/1997