Original Date: October 2020
FEP UM Guideline 005. Hearing Aids
Hearing Aids
DESCRIPTION
A hearing aid is a small electronic device that is worn in or behind the ear. It makes some sounds louder
so that a person with hearing loss can listen, communicate, and participate more fully in daily activities.
A hearing aid has three basic parts: a microphone, amplifier, and speaker. The hearing aid receives
sound through a microphone, which converts the sound waves to electrical signals and sends them to an
amplifier. The amplifier increases the power of the signals and then sends them to the ear through a
speaker. Hearing aids also require a battery as a power source.
Hearing aids are primarily useful in improving the hearing and speech comprehension of people who
have hearing loss that results from damage to the small sensory cells in the inner ear, called hair cells.
This type of hearing loss is called sensorineural hearing loss. The damage can occur as a result of
disease, aging, or injury from noise or certain medicines.
A hearing aid magnifies sound vibrations entering the ear. Surviving hair cells detect the larger vibrations
and convert them into neural signals that are passed along to the brain. The greater the damage to a
person’s hair cells, the more severe the hearing loss, and the greater the hearing aid amplification
needed to make up the difference. However, there are practical limits to the amount of amplification a
hearing aid can provide. In addition, if the inner ear is too damaged, even large vibrations will not be
converted into neural signals. In this situation, a hearing aid would be ineffective.
1
Hearing loss is measured on a scale based on the threshold of hearing. Audiometric testing is used to
measure the frequency and hearing level. Usually frequencies of 250-8000Hz are used in testing. The
American Speech - Language - Hearing Association (ASHA) has defined the degree of hearing loss
based on pure-tone average (PTA). The PTA is the average hearing sensitivity at 500, 1000, and 2000
Hz. Testing may be performed with headphones, insert earphones or sound fields. Sound fields are
testing signals presented via speakers and are usually used with infants, toddlers or individuals with
special needs in which earphones would be problematic.
2,7
Air-conduction testing determines the degree and configuration of hearing loss while bone-conduction
testing determines the type of hearing loss present by comparing air- and bone-conduction thresholds. A
significant difference between air- and bone-conduction scores would suggest a conductive hearing loss.
A speech recognition threshold (SRT) is the lowest level at which 50% of two-syllable words (e.g.,
baseball) can be identified correctly. Like pure tone thresholds, speech reception thresholds are
measured in decibels (dB HL) and should correspond closely to the pure tone average (PTA). Word
recognition testing is performed in order to obtain a measure of one’s ability to identify monosyllabic
words (e.g., yard) presented in a quiet environment. The word recognition score is based on the
percentage of words correctly understood. The above tests are considered to be part of the minimum
recommended test battery.
3
A hearing loss of up to 20 decibels below the hearing threshold is still considered to be normal hearing.
More severe hearing loss can be described according to severity, as follows:
• Mild hearing loss: Hearing loss of 20 to 40 decibels.
• Moderate hearing loss: Hearing loss of 41 to 60 decibels.
Annual Effective Date: January 1, 2024
Related FEP Medical Policies:
7.01.03 Implantable Bone-Conduction and Bone-Anchored
Hearing Aids
7.01.05 Cochlear Implant
7.01.84 Semi-Implantable and Fully Implantable Middle Ear
hearing Aids
E
ffective Date: January 1, 2024
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FEP UM Guideline 005: Hearing Aids
• Severe hearing loss: Hearing loss of 61 to 80 decibels.
• Profound hearing loss or deafness: Hearing loss of more than 81 decibels.
4
A hearing loss of more than 40 decibels is considered to be a hearing impairment.
5
Most manufacturers allow a trial/adjustment period during which hearing aids can be returned for a
refund.
6
OBJECTIVE
This objective of this guideline is to facilitate the use of medically necessary hearing aids.
Thi
s guideline only addresses air conduction hearing aid devices for adults. These include:
• Behind the ear (BTE) device
• In the ear (ITE) device
• In the ear canal (CIC) device
• Contralateral routing of signal (CROS)
This guideline does not address medical necessity for bone anchored, bone-conduction, semi or
fully implantable middle ear hearing aids or cochlear implants. See the related applicable Federal
Employee Program Medical Policies and (FEP) brochure coverage. Consideration should be
given on an individual basis, for hearing loss of 40 decibels or less with a prescription from a
licensed healthcare provider.
CLINICAL REVIEW
H
earing aids are subject to the benefit provisions and limitations as outlined in the Blue Cross
®
and Blue Shield
®
Service Benefit Plan Basic and Standard Option and Blue Cross and Blue Shield
Service Benefit Plan FEP
®
Blue Focus brochures
8,9
and must be medically necessary. The
maximum benefit amount will always apply.
This guideline addresses the initial medical necessity clinical review for air conduction hearing
aid devices as well as when replacement hearing aid(s) are more than 3 years and less than 5
years from the previous hearing aid claim.
You now must obtain prior approval to receive benefit reimbursement for hearing aids.
Medical Necessity* requirements for hearing aids:
1. Must be FDA-approved
2. Dispensed by prescription from a licensed healthcare provider
a. Hearing aid purchase within 6 months of the date of prescription
3. Hearing loss determined and documented by audiometric testing (hearing test) completed in th
e 6
mont
hs prior to hearing aid purchase
Effective Date: January 1, 2024
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FEP UM Guideline 005: Hearing Aids
4. Moderate hearing loss of 40 dB or greater (based on pure tone average tone-conduction
detection threshold) for:
a. conductive hearing loss unresponsive to medical or surgical interventions
b. sensorineural hearing loss
c. mixed hearing loss (combination of conduction hearing loss and sensorineural hearing
loss)
5. Hearing Aid replacement:
a. Documentation of medical necessity for replacement hearing aid to include:
i. Member’s past history of hearing aid use
ii. Pertinent medical history, description of functional status, relevant prior treatment
iii. Comprehensive audiometric testing: date, type of testing and results that
demonstrates the hearing loss and need for a replacement hearing aid
iv. The currently used device is no longer functioning adequately and has been
determined to be non-repairable and is not under warranty, OR
v. Significant change in the person’s hearing that requires a different hearing aid (at
least a 15 dB change in at least one frequency between 500 and 4000 Hz)
vi. Recommendation for type of replacement device
vii. Follow-up plan for assessing effectiveness/outcome of use of the replacement
hearing aid
1. Trial period
2. Warranty information
Not Covered:
1. Accessories which are for convenience and not medically necessary
a. While many hearing aids are now Bluetooth compatible, below are examples of additional
tools that are considered not medically necessary (this list is not all inclusive)
i. Streamer remote/TV adapter (for connection to multiple audio sources such as a
home theater system or smartphone)
ii. Phone clip (allow hearing aid to become a wireless stereo headset)
iii. Remote control (change volume/programs and control other accessories)
iv. Remote microphone
v. Apps
2. Hearing aids that have been returned for a refund during the trial/adjustment period
3. Repair of hearing aid performed under warranty
4. Repair or replacement of hearing aids due to loss, misuse or abuse
5. Over-the-counter hearing aids/ hearing assistive devices/ personal sound amplification products
(PSAPs) available without a prescription.
Effective Date: January 1, 2024
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FEP UM Guideline 005: Hearing Aids
* “Medical necessity shall mean healthcare services that a physician, hospital, or other covered
professional or facility provider, exercising prudent clinical judgment, would provide to a patient for the
purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms,
and that are:
• In accordance with generally accepted standards of medical practice in the United States;
and
• Clinically appropriate, in terms of type, frequency, extent, site, and duration; and considered
effective for the patient’s illness, injury, disease, or its symptoms; and
• Not primarily for the convenience of the patient, physician, or other healthcare provider, and
not more costly than an alternative service or sequence of services at least as likely to
produce equivalent therapeutic or diagnostic results for the diagnosis or treatment of that
patient’s illness, injury, or disease, or its symptoms; and
• Not part of or associated with scholastic education or vocational training of the patient; and
• In the case of inpatient care, able to be provided safely only in the inpatient setting.
8,9
for
References
1. National Institute on Deafness and Other Communication disorder (NIDCD). Available at:
https://www.nidcd.nih.gov/health/hearing-aids
Accessed February 2023.
2. American Speech-Language-Hearing Association (1988). Determining threshold level for speech
[guidelines]. Available online at: https://www.asha.org/policy/gl1988-00008/
. Accessed February
2023.
3. Davis, C., et.al. Demystifying hearing assistance technology: A guide for service providers and
consumers, 2007. Available online at:
https://www.nationaldeafcenter.org/sites/default/files/Demystifying.pdf
. Accessed February 2023.
4. Hearing Health Foundation. Degrees of Hearing Loss. Available at:
https://hearinghealthfoundation.org/degrees-of-hearing-loss
. Accessed February 2023.
5. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care
(IQWiG); 2006-. Hearing loss and deafness: Normal hearing and impaired hearing. 2008 May 15
[Updated 2017 Nov 30]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK390300/. Accessed
February 2023.
6. U.S. Food and Drug Administration. How to Get Hearing Aids. (Updated 2022, Nov 18) Available at:
https://www.fda.gov/medical-devices/hearing-aids/how-get-hearing-aids
Accessed February 2023.
7. Kutz, J., Audiology Pure-tone Testing, August 2018;
https://emedicine.medscape.com/article/1822962-
overview#:~:text=Usually%20frequencies%20of%20250%E2%80%938000,can%20detect%20even%
20higher%20frequencies.&text=Pure%2Dtone%20average%20(PTA),500%2C%201000%2C%20and
%202000. Accessed February 2023
8. 2023 Blue Cross ® and Blue Shield ® Service Benefit Plan brochure (RI 71-005)
9. 2023 Blue Cross ® and Blue Shield ® Service Benefit Plan FEP ® Blue Focus brochure (RI 71-017)
HISTORY – This policy was approved by the FEP
®
Pharmacy and Medical Policy Committee
according to the history below:
Date
Action
September 2020
New guideline
March 2021
Update
Effective Date: January 1, 2024
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FEP UM Guideline 005: Hearing Aids
March 2022
Update
decibels; severe range changed to 61-90;
profound to more than 90 decibels. Medical
necessity requirements unchanged. Reference
March 2023
decibels; severe range changed to 61-80;
profound to more than 81 decibels. Medical
necessity requirements unchanged. References
December 2023
reimbursement benefit for hearing aids verbiage
included to align with the 2024 FEP Service
The policies/guidelines contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are
not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue
Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy/guideline, to recommend, advocate, encourage or
discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health
care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield
Service Benefit Plan covers (or pays for) this service or supply for a particular member
No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise,
without permission from the health plan.