This document addresses the use of air conduction hearing aids in the treatment of individuals with hearing loss.

Note: Please see the following documents related to other treatments and devices for the treatment of hearing loss:

• CG-SURG-81 Cochlear Implants and Auditory Brainstem Implants
• CG-SURG-82 Bone-Anchored and Bone Conduction Hearing Aids
• SURG.00084 Implantable Middle Ear Hearing Aids

Note: Benefit language supersedes this document. Hearing aids are not a covered benefit under all member contracts/certificates. Please see the text in the footnote of this document regarding Federal and State mandates and applicable benefit plan contract language, as contract terms, conditions and limitations of coverage within these documents may specifically address the topic of hearing aids.

Clinical Indications

Medically Necessary:

Air conduction hearing aid devices are considered medically necessary for the treatment of hearing loss when ALL of the following criteria are met (A and B):

1. The hearing loss is due to one of the following etiologies:
   1. Sensorineural hearing loss; or
   2. Mixed hearing loss; or
   3. Conductive hearing loss which has been:
      1. unresponsive to medical interventions; and
      2. unresponsive to surgical interventions or not amenable to surgical correction; and
2. The degree of hearing loss is confirmed by audiometry or other age-appropriate testing to be greater than or equal to 26 decibels (dB).

Binaural air conduction hearing aids are considered medically necessary when BOTH of the following criteria are met (A and B):

1. Both ears meet the criteria listed above in A and B; and
2. Binaural testing shows improved speech recognition using bilateral devices.

Air conduction hearing aid devices with advanced technology models and features (for example, in-the-ear and in-the-ear-canal models with digital signal processing, directional microphones, multiple channels/memories) are considered medically necessary when the technology enhancement is needed to improve the hearing quality for the wearer.

Replacement of an air conduction hearing aid device that is out of warranty and no longer functioning adequately to support activities of daily living is considered medically necessary when the device is malfunctioning and cannot be refurbished or repaired sufficiently to resume its original functionality.

Not Medically Necessary:

Air conduction hearing aid devices are considered not medically necessary when the above criteria are not met.

Air conduction hearing aid devices with advanced technology models and feature enhancements (for example, in-the-ear and in-the-ear-canal models with digital signal processing, directional microphones, multiple channels/memories) are considered not medically necessary when provided solely for the convenience of the wearer or to improve his/her cosmetic appearance.

Replacement of a currently functional air conduction hearing aid device that is still under warranty for the sole purpose of obtaining a device with updated technology, (commonly referred to as an "upgrade"), is considered not medically necessary unless the new updated device will provide a significant functional advantage over the device that was originally issued.