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

Hearing Aids (CPB 0612, reviewed 2026-09-23)

Effective date
Not stated in the notice
Identified
Oct 3, 2026

Summary

Aetna considers air conduction hearing aids medically necessary when hearing thresholds are 40 dB HL or greater at 500, 1000, 2000, 3000, or 4000 Hz, or 26 dB HL or greater at three of these frequencies, or when speech recognition is less than 94 percent, and bilateral air conduction hearing 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. Air conduction hearing aids for improvement of balance, cartilage conduction hearing aids, hearing aids and semi-implantable hearing aids for all other indications (including improvement of depression and cognitive decline in the elderly), and a free-floating piezoelectric microphone in an implantable hearing aid are considered experimental, investigational, or unproven.

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What to do

Action · 8 steps
01Bill CPT codes 0951T through 0955T and HCPCS codes S2230, V5030, V5050, V5070 and V5095 only when the selection criteria in this policy are met.
02For air conduction hearing aids, the criteria are hearing thresholds of 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, with bilateral aids meeting these thresholds in each ear.
03Diagnoses H90.3 through H90.8 and Q16.1 are covered when the selection criteria are met.
04Diagnoses F32.0 - F32.9, F33.0 - F33.9, H81.311 - H81.399, H81.8X1 - H81.8X9, H81.90 - H81.93, H82.1 - H82.9 and R41.81 are listed as not covered for the indications in this policy.
05Implantable and semi-implantable hearing aids require moderate-to-severe sensorineural hearing impairment and an inability to tolerate an ear mold because of medical conditions.
06Hearing aids are eligible for coverage in plans that do not exclude them only if they are FDA-cleared and prescribed by a qualified healthcare provider and the medical necessity criteria are met.
07Check benefit plan descriptions for hearing aid exclusions and limitations, because most Aetna benefit plans exclude coverage of hearing aids.
08Cartilage conduction hearing aids have no specific HCPCS code and are considered experimental, investigational, or unproven.

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 2026-09-23)
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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