Implantable Bone-Conduction and Bone-Anchored Hearing Aids

This policy covers implantation of fully or partially implantable bone‑conduction (bone‑anchored) hearing aids as an alternative to air‑conduction or CROS devices for individuals (generally age ≥5) with conductive or mixed hearing loss, single‑sided deafness, congenital or surgical external/middle ear malformations, chronic external/middle ear disease, or other conditions that contraindicate air‑conduction aids. Coverage is limited to fully insured Illinois PPO/HMO/POS plans effective 2025‑01‑01, requires device‑specific bone‑conduction PTA thresholds and >60% speech discrimination in the indicated ear plus a documented contraindication to air‑conduction hearing aids, excludes purely sensorineural bilateral loss and patients <5 years, and mandates symmetric‑hearing criteria for bilateral implantation.

"Coverage of therapy necessary to increase quality of life for children with qualifying conditions."