CMS Pub. 100-02, ch. 16, § 100

Section 1862(a)(7) of the Social Security Act states that no payment may be made under

part A or part B for any expenses incurred for items or services “where such expenses are

for . . . hearing aids or examinations therefore. . . .” This policy is further reiterated at

42 CFR 411.15(d) which specifically states that “hearing aids or examination for the

purpose of prescribing, fitting, or changing hearing aids” are excluded from coverage.

Hearing aids are 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.

Certain devices that produce perception of sound by replacing the function of the middle

ear, cochlea or auditory nerve are payable by Medicare as prosthetic devices. These

devices are indicated only when hearing aids are medically inappropriate or cannot be

utilized due to congenital malformations, chronic disease, severe sensorineural hearing

loss or surgery.

The following are prosthetic devices:

• Cochlear implants and auditory brainstem implants, i.e., devices that replace the

function of cochlear structures or auditory nerve and provide electrical energy to

auditory nerve fibers and other neural tissue via implanted electrode arrays.

• Osseointegrated implants, i.e., devices implanted in the skull that replace the

function of the middle ear and provide mechanical energy to the cochlea via a

mechanical transducer.

Medicare contractors deny payment for an item or service that is associated with any

hearing aid as defined above. See §180 for policy for the medically necessary treatment

of complications of implantable hearing aids, such as medically necessary removals of

implantable hearing aids due to infection.