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AetnaCommercial · Coverage · Medical Policy · Audiology, ENT (Ear, Nose & Throat)Medium impact

Hearing Aids (CPB 0612, reviewed 2026-03-02)

Effective date
Not stated in the notice
Identified
Aug 16, 2026

Summary

Aetna's Clinical Policy Bulletin 0612 covers air conduction, implantable and semi-implantable hearing aids. Air conduction hearing aids are medically necessary when hearing thresholds are 40 dB HL or greater at 500, 1000, 2000, 3000, or 4000 Hz, 26 dB HL or greater at three of these frequencies, or speech recognition is less than 94 percent, and bilateral aids are medically necessary when these thresholds are met in each ear. Implantable and semi-implantable hearing aids are medically necessary for members with moderate-to-severe sensorineural hearing impairment who cannot tolerate an ear mold because of medical conditions such as auricular atresia or severe chronic otitis externa, while air conduction hearing aids for balance, cartilage conduction hearing aids, and hearing aids for all other indications, including depression and cognitive decline in the elderly, are considered experimental, investigational, or unproven.

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What to do

Action · 7 steps
01Billing team: Bill air conduction hearing aids only when the member's hearing thresholds meet the criteria in the policy (40 dB HL or greater at 500, 1000, 2000, 3000, or 4000 Hz, 26 dB HL or greater at three of these frequencies, or speech recognition less than 94 percent), and document that the criteria were met in both ears for bilateral aids.
02For implantable or semi-implantable hearing aids, confirm the member has moderate-to-severe sensorineural hearing impairment and cannot tolerate an ear mold because of a medical condition.
03For over-the-counter FDA-cleared hearing aids, confirm the member has a prescription for the device from a physician or provider licensed to prescribe hearing aids and has been evaluated and meets the medical necessity criteria.
04Covered CPT codes 0951T through 0955T, HCPCS codes S2230, V5030, V5050, V5070 and V5095, and ICD-10 codes H90.3 through H90.8 and Q16.1 apply when the selection criteria are met.
05Do not bill air conduction hearing aids for balance improvement, cartilage conduction hearing aids, or hearing aids for depression or cognitive decline in the elderly, because Aetna considers these experimental, investigational, or unproven.
06Do not bill hearing aids for indications with the ICD-10 codes listed as not covered, including F32.0 through F32.9, F33.0 through F33.9, H81.311 through H81.399, H81.8X1 through H81.8X9, H81.90 through H81.93, H82.1 through H82.9, and R41.81.
07Check the member's benefit plan description before billing, because most Aetna benefit plans exclude coverage of hearing aids, and those exclusions and limitations apply to all three types of hearing aid.

Codes mentioned

926289262992631926329263492635926369263792638926399264192642S2230V5030V5050V5070V5095H90.3H90.8Q16.1F32.0F32.9F33.0F33.9H81.311H81.399H81.8X1H81.8X9H81.90H81.93H82.1H82.9R41.81

Original notice

Hearing Aids (CPB 0612, reviewed 2026-03-02)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesAudiologyENT (Ear, Nose & Throat)Code 92628Code 92629Code 92631Code 92632Code 92634Code 92635Code 92636Code 92637Code 92638Code 92639Code 92641Code 92642Code S2230Code V5030Code V5050Code V5070Code V5095Code H90.3Code H90.8Code Q16.1Code F32.0Code F32.9Code F33.0Code F33.9Code H81.311Code H81.399Code H81.8X1Code H81.8X9Code H81.90Code H81.93Code H82.1Code H82.9Code R41.81

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