HMSA's plans cover hearing aids that are necessary to correct hearing loss. Benefits are available for hearing aid models (analog, digital, digitally programmable) with standard features. Such services are subject to plan deductibles and coinsurance percentages.
The following information applies to members enrolled in the following coverage codes: 455, 532, 533, 558, 651, 669, and 673. For all other coverage codes, please refer to the Hearing Aids - ACA Plans.
Members who are enrolled in the coverage codes above will continue to have a maximum eligible of $600 per hearing aid regardless of what type of hearing aid is chosen. The non-covered services and features listed below will continue to deny as member responsible.
NOTE: Under HMSA benefit guidelines, hearing aids are limited to one hearing aid per ear every 60 months. Benefit payments for standard hearing aids are limited to no more than the eligible charge.
Non-Covered Services and Features
Members are responsible for separately charged costs related to nonstandard (cosmetic, convenience or advanced technology) features that include, but are not limited to:
- Replacement battery for use in hearing device
- Extended warranty
- Ear mold and/or insert
- Hearing aid accessories (i.e., dry and store kits)
- Dispensing fee
- Bluetooth accessories
- Automatic volume control (compression)
- Ear impressions
- Low-battery indicator
- Conformity evaluation
- Fitting, adjustment, orientation, and/or checking of a hearing aid
- Insurance against loss or damage
Claims Filing Information
Please refer to CMS 1500 Claim Form - General Instructions for general claims filing instructions. However, we also ask that you refer to the information below to address any specific questions you may have about filing claims for hearing aids.
The important difference in filing hearing aid service claims is that in Block 24D, located at the bottom center of the form, providers must be sure to record the following:
- Procedure Code: Enter appropriate procedure code to indicate the appliance provided.
- Modifier LT (left) or RT (right) are required when billing for monaural hearing aids.
- When billing for binaural hearing aids, modifier LT or RT is not required because binaural applies to both ears. The binaural hearing aids must be billed with a quantity of 1 unit.
- Charges for nonstandard features are entered on a separate line below the standard code. Charges for nonstandard features are billed with HCPCS code S1001 and the member will be held liable.
Filing claims for repairs and replacements
Effective 1/1/2022, precertification is required for hearing aid repairs and replacements. Please refer to the medical policy for Durable Medical Equipment, Prosthetics and Orthotics for more information.
- When billing for replacement hearing aids, modifier RA is required.
- Use HCPCS V5014 when billing for a repair.
- When submitting a precertification request for repairs, please include an invoice.
Claims Filing Examples
The following examples illustrate how to file claims for hearing aids with standard and nonstandard features. The provider may bill the patient for nonstandard features. In some cases, HMSA may request an itemization of all charges. To prevent misunderstandings, providers are urged to discuss the financial responsibility for the non-covered services with the member prior to dispensing the devices.
Example A
A patient is equipped with a standard monaural ITE device for the right ear (V5050). The provider's charge for the hearing aid is $800. The patient's plan benefit for hearing aid(s) is 80% of the eligible charge after a $100 deductible has been applied.
| Standard Code | Code Description | Modifier | Charges | HMSA Eligible | Provider Adjustment | HMSA Allowance | Member Owes |
|---|---|---|---|---|---|---|---|
| V5050 | Hearing aid, monaural, in the ear | RT | $800 | $600 | $0.00 | $400 | $400 |
Example B
A patient is equipped with a single standard ITC device for the left ear (V5245), and wants a nonstandard Bluetooth accessory (S1001). The patient's plan benefit for hearing aid(s) is 80% of the eligible charge after a $100 deductible has been applied. (Note that standard and nonstandard features are billed on two separate lines using appropriate codes):
| Standard Code | Code Description | Modifier | Charges | HMSA Eligible | Provider Adjustment | HMSA Allowance | Member Owes |
|---|---|---|---|---|---|---|---|
| V5245 | Hearing aid, digitally programmable, analog, monaural, ITC | LT | $ 600 | $ 600 | $0.00 | $400 | $ 200 |
| S1001 | Deluxe item, patient aware (list in addition to code for basic item) | LT | $ 1,000 | $0.00 | $0.00 | $0.00 | $ 1,000 |
| Total | $ 1,600 | $ 600 | $0.00 | $400 | $ 1,200 |
Example C
A patient is equipped with a digital binaural ITC hearing aid, left ear and right ear. The patient also wants hearing aid accessories that are non-covered (S1001). The patient’s plan benefit for hearing aid(s) is 80% of the eligible charge.
| Standard Code | Code Description | Modifier | Charges | HMSA Eligible | Provider Adjustment | HMSA Allowance | Member Owes |
|---|---|---|---|---|---|---|---|
| V5259 | Hearing aid, digital, binaural, ITC | LTRT | $ 2,800 | $ 1,200 | $0.00 | $960 | $ 240 |
| S1001 | Deluxe item, patient aware (list in addition to code for basic item) | LTRT | $ 2,690 | $0.00 | $0.00 | $0.00 | $ 2,690 |
| Total | $ 5,490 | $ 1,200 | $0.00 | $960 | $ 2,930 |
Returns
If a newly dispensed hearing aid is returned by the member, any benefit payment made by HMSA for the hearing aid should be returned to HMSA.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |