FEP BCBS Policy Update/Correction

On Friday, April 5, the Academy reported that FEP BCBS (Federal Employee Program Blue Cross Blue Shield) had released its updated hearing aid coverage guideline. That report did not reflect the most up-to-date changes made to the policy. Mid-day on April 8, BCBS released the full coverage update. 

The significant changes to Utilization Guideline 005: Hearing Aids are in the following sections:

OBJECTIVE

1. Removes reference to adults
   
   • ORIGINAL LANGUAGE: This guideline only addresses air conduction hearing aid devices for adults.
   • UPDATED LANGUAGE: This guideline only addresses air conduction hearing aid devices.
     
2. Removes the phrase: “Consideration should be given on an individual basis for hearing loss of 40 decibels or less with a prescription from a licensed healthcare provider.

MEDICAL NECESSITY

1. Clarification was added regarding the FDA requirement for hearing aids:
   
   • ORIGINAL LANGUAGE: For medical necessity, hearing aids must be FDA-approved
   • UPDATED LANGUAGE: For medical necessity, hearing aids must be approved, listed/or registered with the FDA as a prescription device.

2. Clarification was added regarding the dispensing provider
   
   • ORIGINAL LANGUAGE: Dispensed by prescription from a licensed healthcare provider
   • UPDATED LANGUAGE:  Dispensed by prescription or signed written order from a licensed healthcare provider who is practicing within the scope of their license.

3. Degree of hearing loss amended:
   
   • ORIGINAL LANGUAGE: Moderate hearing loss of 40 dB or greater (based on pure tone average-tone conduction detection threshold
   • UPDATED LANGUAGE: The degree of hearing loss is confirmed by audiometry or other age-appropriate testing to be greater than 26 dB hearing loss