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Coverage criteria policies

Hearing aids – Minnesota Health Care Programs

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for hearing aids.

Prior authorization is not required for bone anchored hearing aids (BAHA), including batteries and replacement parts.

This policy does not address cochlear implants for treatment of hearing loss. Please check your plan documents or contact Member Services for specific information on this service.

Coverage

Hearing aids are generally covered per the indications below and per your plan documents.

Indications that are covered

Standard hearing aid coverage criteria:

Hearing aid services are an MHCP covered service; in addition to dispensing hearing aids, hearing aid services include:

  • Batteries
  • Ear impressions
  • Ear molds, including open dome style ear molds (not disposable) replaced about every 3 months
  • Hearing aid checks (programming)
  • Hearing aid repairs
  • Parts and Accessories
  • Programming/reprogramming
  • Re-casing, re-makes, shell modifications
  • Replacing battery doors

MHCP does not reimburse hearing aid service providers separately for audiologic evaluations, hearing aid exams and selection, or home visits.

Replacement

MHCP covers one hearing aid or set of binaural hearing aids within a period of five years for an eligible recipient. If hearing aids must be replaced due to change in hearing, or hearing aid loss, theft, or irreparable damage, the provider must request authorization for a new aid. MHCP considers the recipient's physical or mental impairment in determining whether circumstances were beyond the recipient's control if the aid is lost or broken and will only approve a replacement in those cases.

BAHA coverage criteria

These devices are covered only when the provider determines that standard (non-BAHA) hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss, or previous surgery

Indications that are not covered

Replacement batteries provided on a scheduled basis regardless of actual need

Services specified as part of the contract price when billed separately for payment, including charges for repair of hearing aids under warranty

Routine screening of individuals or groups for identification of hearing problems

Separate reimbursement for postage, handling, taxes, mileage, or pickup and delivery

Disposable hearing aids, non-electronic hearing aids, battery chargers,

Alarm systems including but not limited to:

  • Vibrating bed alarms
  • Doorbell transmitters (door announce
  • Baby monitors
  • Personal signaling system

Adapters for telephones, television, or radio, including but not limited to:

  • Telephone amplifiers
  • Amplifying phone handsets
  • Visual telephone ringers
  • Personal television and radio amplifying systems

Hearing aid maintenance and retention products including but not limited to:

  • Swim molds/swim plugs
  • Ear plugs
  • Swimmers’ headband
  • Dry aid kits and dehumidifiers
  • Moisture guard (i.e., Super Seals®)
  • Wax filters, wax guards, cerumen guards
  • Microphone protectors
  • Retention cords and safety clips such as OtoClips and Critter Clips™

Ear care and comfort products including but not limited to:

  • Ear comfort creams
  • Ear cleansers/cleaning solution
  • Wax removal kits/systems
  • Hearing aid pads

Regularly scheduled maintenance, cleaning, and checking of hearing aids, unless there has been a request or referral for the service by the person who owns the hearing aid, the person's family, guardian or attending physician

Loaner hearing aid charges

Canal type hearing aids [In-the-Canal (ITC) and Completely-in-the-Canal (CIC)]

Non-contract hearing aids obtained without authorization

Services included with the dispensing fee when billed separately

Hearing aid services to a resident of an LTC facility if the services did not result from a request by the resident, a referral by a registered nurse or licensed practical nurse who is employed by the LTC facility, or a referral by the resident's family, guardian or attending physician

Definitions

Bone anchored hearing aids (BAHAs) - surgically implanted hearing devices that transmit sound directly to the inner ear through bone, bypassing the external auditory canal and middle ear. BAHAs consist of an external sound processor and a titanium implant that is affixed to the temporal bone of the skull. The sound processor vibrates the implant, which in turn vibrates the temporal bone. That vibration is then transmitted through other bones to the cochlea of the opposite ear, where it creates the sensation of sound

FM System- a wireless system designed to help someone better identify and understand speech in noisy situations and over distances of up to 50 feet. Some FM systems work along with hearing aids, while others are designed for those with normal hearing. The person speaking wears or holds a transmitter microphone (or places this in the middle of a group). The transmitter picks up speech sounds and uses radio waves to send these to one or more FM receivers, which a person can wear behind the ear or connected to a hearing aid

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Hearing Aid Services Codes

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor

Item /service must be received from a contracted vendor, Audiology, or ENT provider.

References

  1. Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_146171
  2. Hayes, Inc. Hayes Medical Technology Directory Report. Bone Anchored Hearing Aids. Lansdale, PA: Hayes, Inc.; June, 2005. Reviewed September, 2009. Archived July, 2010.
  3. ECRI Institute. (2017). Bone-anchored Hearing Aid Implants for Treating Conductive and Mixed Hearing Loss. Plymouth Meeting, PA: ECRI Institute

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Policy activity

  • 01/01/1994 - Date of origin
  • 11/01/2016 - Effective date
Review date
  • 10/2018
Revision date
  • 02/21/2017

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