Examples of semi-implantable electromagnetic hearing aids include, but may not be limited to, Vibrant soundbridge system, Maxum system, Otomag alpha 1(M) bone conduction hearing system and Semi-Implantable middle ear transducer (MET) ossicular stimulator system. Partially implantable or semi implantable electromagnetic hearing aids, also called bone conduction hearing aids, create an electromagnetic field that vibrates and stimulates the ossicles, sending signals to the cochlea. Examples of totally implantable hearing systems include, but may not be limited to, Esteem totally implantable hearing system and Carina fully implantable hearing device. Implantable hearing systems (middle ear implants), in which all components are inserted within an individual, are purported to be an alternative to the traditional over the ear hearing aid. Major depressive disorder, single episode ICD-10 codes not covered for indications listed in the CPB: Sensorineural hearing loss and mixed conductive and sensorineural hearing lossĬongenital absence, atresia and stricture of auditory canal (external) ICD-10 codes covered if selection criteria are met:: Semi-implantable middle ear hearing prosthesis Hearing aid, monaural, body worn, air conduction Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear HCPCS codes covered if selection criteria are met:: Codes requiring a 7th character are represented by "+": Information in the below has been added for clarification purposes.
V5261 hearing aid code#
Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Please check benefit plan descriptions for details.įor plans that do not exclude hearing aids, either OTC and prescription hearing aids are eligible for coverage if they are cleared by the FDA and prescribed by a qualified healthcare provider and medical necessity criteria for hearing aids above are met. Any applicable benefit plan exclusions and limitations for coverage of hearing aids would apply to air conduction hearing aids, implantable hearing aids and semi-implantable hearing aids. Note: Most Aetna benefit plans exclude coverage of hearing aids. Speech recognition less than 94 percent.Īetna considers implantable hearing aids (e.g., the Esteem implantable hearing system and the Carina prosthesis) and semi-implantable hearing aids (e.g., the Maxum system and the Vibrant Soundbridge) medically necessary for members who have moderate-to-severe sensorineural hearing impairment and can not tolerate an ear mold because of medical conditions (such as auricular atresia or severe chronic otitis externa).Īetna considers implantable hearing aids and semi-implantable hearing aids experimental and investigational for all other indications (including for improvement of depression and cognitive decline in the elderly) because its effectiveness for indications other than the ones listed above has not been established.Īetna considers the use of free-floating piezoelectric microphone in an implantable hearing aid experimental and investigational because the effectiveness of this approach has not been established.Īetna considers the Bose Hearing Aid and other FDA-cleared hearing aids available over the counter without a prescription as medically necessary equally effective alternatives to hearing aids available only by prescription for persons whose hearing has been evaluated and meet medical necessity criteria for air conduction hearing aids, and the member has a prescription for the hearing aid from a physician or provider licensed to prescribe hearing aids.Hearing thresholds 26 dB HL or greater at three of these frequencies or.Hearing thresholds 40 decibels (dB) HL or greater at 500, 1000, 2000, 3000, or 4000 hertz (Hz) or.Number: 0612 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪir conduction hearing aids are considered medically necessary when the following criteria are met:
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