Semi-Implantable and Fully Implantable Middle Ear Hearing Aids

This policy addresses semi‑implantable and fully implantable middle ear hearing aids for patients with moderate-to-severe sensorineural bilateral hearing loss who cannot use standard external hearing aids (for example due to congenital/surgically induced external or middle ear malformations, chronic otitis, tumors, or dermatitis) and for medically necessary hearing care related to craniofacial anomalies. Coverage is limited to medically necessary uses and subject to member benefit restrictions, generally requires that external or bone‑conduction aids be unsuitable, limits hearing aids and molds to two devices and two molds per ear every two years, treats most fully implantable devices (and many semi‑implantable indications) as experimental/investigational except the FDA‑approved Esteem® system for adults ≥18 with stable moderate‑to‑severe sensorineural loss, and the policy is listed as inactive for claims adjudication.

"Reconstructive surgery and related medical care for any age diagnosed with a craniofacial anomaly when surgery/treatment is medically necessary to improve a functional impairment resulting from the..."