Hearing Aid Supplies

Policy No: 152
Originally Created: 11/01/2024
Section: Administrative
Last Reviewed:
Last Revised:
Approved: 11/14/2024
Effective Date: 01/01/2025
Policy Applies To: Group and Individual

This policy applies to facilities, physicians, suppliers and other qualified health care professionals.

Binaural Hearing Aid – hearing aids for both ears. This type of device allows the brain to process information from both ears.

Hearing Aid – amplifying devices that compensate for impaired hearing. Hearing aids include air conduction devices that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound. They also include bone conduction devices that provide mechanical energy to the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles.

Monaural Hearing Aid – hearing aid worn in one ear. This type of device works independently, focusing solely on the ear it is in.

Otolaryngologist - a licensed physician who is qualified to engage in the practice of otolaryngology by reason of having passed or received training acceptable for admission to the examination of the American Board of Otolaryngology. Such a physician normally confines his/her practice to the problems of the ears, pharynx, larynx, nasopharynx, and the tracheo-bronchial tree.

Our health plan evaluates claims for reimbursement of hearing aids, based on procedure codes, diagnoses, and documentation provided. Hearing related services and equipment should be billed using the most appropriate CPT/HCPCS codes. All hearing aid related products and services should be billed on one claim with each product or service on a separate line item with the applicable codes, number of units and the individual charged amounts.

A hearing aid purchase typically includes the hearing test, consultation, initial fitting, and all follow-up adjustments, routine cleanings and a warranty (from the manufacturer) that can range from one to three years. Hearing aid warranties often cover all repairs and include a one-time replacement policy if you lose a hearing aid.

In the event a member chooses to upgrade to a deluxe hearing aid that exceeds our reimbursement cap, please refer to the billing guidelines on our website here: Professional reimbursement.

Monaural hearing aids: a RT or LT modifier is required for reimbursement. Claims submitted without the RT or LT modifier may be denied.

Binaural hearing aid: RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.

If supplemental accessories, including batteries, chargers, docking stations, etc. come with the device, then they are considered included in the original purchase price of the hearing aid device itself.

Future services or supplies need to be billed on the date of service rendered.

This policy does not apply to surgically anchored bone conduction hearing aids or externally worn air conduction hearing aids. Cochlear implants are not hearing aids. While hearing aids function by amplifying sound, cochlear implants replace the functions of an absent or nonfunctioning cochlea.

The codes listed in this policy are for reference purposes only. Listing a service or device code in this policy does not imply that the service described by this code is a covered or non-covered service. Coverage is determined by the Member’s plan of benefits or Certificate of Coverage.

Note: The list of codes, in the table below, may not be all inclusive:

Center for Medicare and Medicaid Services (CMS) Medicare Benefit Policy Manual Chapter 16 Section 100

Code of Federal Regulations Title 21 Chapter I Subpart H

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