Hearing Aid and Supplies

Policy No: 152
Originally Created: 11/01/2024
Section: Administrative
Last Reviewed: 09/1/2025
Last Revised: 09/1/2025
Approved: 09/11/2025
Effective Date: 01/01/2026
Policy Applies To: Group and Individual

This policy applies to physicians, suppliers and other qualified health care professionals.

Binaural Hearing Aid – hearing aids for both ears. This type of device allows the brain to process information from both ears.

Hearing Aid – amplifying devices that compensate for impaired hearing. Hearing aids include air conduction devices that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound. They also include bone conduction devices that provide mechanical energy to the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles.

Monaural Hearing Aid – hearing aid worn in one ear. This type of device works independently, focusing solely on the ear it is in.

Otolaryngologist - a licensed physician who is qualified to engage in the practice of otolaryngology by reason of having passed or received training acceptable for admission to the examination of the American Board of Otolaryngology. Such a physician normally confines his/her practice to the problems of the ears, pharynx, larynx, nasopharynx, and the tracheo-bronchial tree.

Note: This policy has been revised and renamed. This policy is not effective until 1/1/2026. To view the current policy, click here.

Our health plan processes claims for reimbursement of hearing aids, based on procedure codes, diagnoses, and documentation provided.

While a hearing aid purchase typically includes the hearing test, consultation, initial fitting, and all follow-up adjustments, routine cleanings and a warranty (from the manufacturer) that can range from one to three years, we require all future services or supplies to be billed on the actual date of service. Hearing aid warranties often cover all repairs and include a one-time replacement policy if you lose a hearing aid. If supplemental accessories, including batteries, chargers, docking stations, etc. come with the device, then they are considered included in the original purchase price of the hearing aid device itself. Items or services covered under manufacturer warranty should not be billed separately.

Monaural hearing aids: a RT or LT modifier is required for reimbursement. Claims submitted without the RT or LT modifier may be denied.

Binaural hearing aid: RT or LT modifier is not required. Claims submitted with a RT or LT modifier will be denied as inappropriately billed.

If a member chooses to upgrade to a hearing aid product above our reimbursement amount, the member should complete a Non-Covered Services Member Consent Form. (Note: This does not apply to BlueCard members, unless the member does not have benefits.)

Evaluation and Management (E/M) visit complexity add-on code (i.e., G2211). Note: Group and Individual lines of business only.

In this case, providers should use HCPCS S1001 Deluxe item, patient aware (list in addition to code for basic item) when billing for the cost in excess of the standard product. The signed Non-Covered Services Member Consent Form must be on file if a request for the form at a future date.

Providers with standard (non-negotiated) agreements with Regence and suppliers can check reimbursement rates for hearing aids on Availity Essentials: Claims & Payment>Fee Schedule Listing>Fee Schedules.

This policy does not apply to surgically anchored bone conduction hearing aids. While bone conducting hearing aids meet the definition of a hearing aid, they are not in scope for this policy. Additionally, cochlear implants are not considered hearing aids under this policy, as they replace the functions of an absent or nonfunctioning cochlea rather than amplify sounds like traditional hearing aids.

The codes listed in this policy are for reference purposes only. Listing a service or device code in this policy does not imply that the service described by this code is a covered or non-covered service. Coverage is determined by the Member’s plan of benefits or Certificate of Coverage. This list of codes below may not be all inclusive.

Center for Medicare and Medicaid Services (CMS) Medicare Benefit Policy Manual Chapter 16 Section 100

Code of Federal Regulations Title 21 Chapter I Subpart H

Washington Legislation RCW 48.43.135 Hearing instruments—Coverage

IDAPA 18 - Department of Insurance.book - Pg 17 (sec.o) IDAPA 18.04.12, The Small Employer Health Insurance and Availability Act

Oregon Legislation ORS 743A.141 – Hearing aids and assistive listening devices

None