Different Types of Hearing Aids: Styles, CROS and Technology Levels

The types of hearing aids, and how official lists count them

The count depends on who is counting. NIDCD, the federal hearing research institute, names three basic styles: behind the ear, in the ear and canal aids. FDA's types page has four entries: behind the ear, mini behind the ear (also called receiver in canal, or RIC), in the ear, and the in-the-canal and completely-in-the-canal pair. Count ITC and CIC apart and FDA's list reaches five.

Both lists sort mainly by size and where the device sits. Billing sorts differently. The October 2026 CMS list of V5 codes holds 88 labels. By our search of those labels, 13 say ITE or in the ear, 12 say BTE or behind the ear and 6 say CIC. RIC, IIC and the word invisible appear in none of them. A missing word doesn't show that a device goes unpaid; it shows only that this list doesn't name it.

The table above sets those labels next to what the national Medicaid file holds for 2023-2024, with 2024 still preliminary. Rows marked Amount shown clear our ten-biller floor, and their paid amounts are on how much hearing aids cost, along with GAO's reported price range. This page prints no amount per code and no price difference between styles.

Behind-the-ear hearing aids

FDA describes these aids as having most parts in a small plastic case that rests behind the ear, joined by clear tubing to an earmold or earpiece. NIDCD's wording is a "hard plastic case worn behind the ear" connected to a plastic earmold. FDA calls the style "easy to clean and handle" and relatively sturdy.

Receiver in canal sits inside this family on FDA's page: a smaller case behind the ear, with a narrow tube running to the ear canal. Its earpiece can be small or a traditional earmold.

These are the busiest rows in the table. V5140, labeled binaural, behind the ear, has 23,560 lines from 66 billers. V5261, digital for both ears, has 20,790 lines from 88 billers. V5257, digital for one ear, has 13,548 lines from 25 billers. Since the labels never say RIC, the file can't tell you how many of those lines were receiver-in-canal aids, so we don't estimate it.

In-ear hearing aids: ITE, ITC and CIC

People searching for in-ear hearing aids may mean any of three sizes.

• In the ear (ITE): all the parts sit in a shell that fills the outer part of the ear. FDA notes these are larger than canal aids and "may be easier to handle than smaller aids."
• In the canal (ITC): NIDCD says this one is made to fit the size and shape of the wearer's ear canal.
• Completely in the canal (CIC): the smallest group on FDA's page, along with ITC. FDA adds that the small size may make them "difficult to handle and adjust."

The billing record thins out as the device shrinks. V5256, digital ITE for one ear, has 6,404 lines from 6 billers. V5130, binaural in the ear, has 2,237 lines from 10 billers, and V5260, digital ITE for both ears, has 522 lines from 14 billers. V5255, digital ITC for one ear, has 750 lines, all from one biller.

Three rows are empty: V5254 and V5258 for digital CIC, and V5259 for digital ITC in both ears. An empty row is not proof that nobody received one or that Medicaid refuses to pay. The source masks small cells, and it covers only what Medicaid paid for.

Which styles the VA buys: CHA, BTE and RIC

One federal buyer publishes its purchases by style. The VA's hearing aid procurement report for October 2025 through September 2026 gives one worksheet per group and category. We added every category worksheet in its three style groups: custom hearing aids (CHA), behind the ear (BTE) and receiver in canal (RIC). Each group has non-rechargeable, rechargeable, multiple processor(s) and SCIF (sensitive compartmented information facility) categories, and RIC adds a fifth for advanced receivers. The CHA and BTE SCIF worksheets show no total.

Of 972,212 units in those worksheets, RIC accounts for 772,207 (79.4%), CHA for 184,715 (19.0%) and BTE for 15,290 (1.6%). The multiple processor(s) category alone holds 512,733 of them, more than half. Wireless and FM systems, remote controls, CROS, compatible devices and chargers sit in other groups and are left out.

These are units one buyer bought for veterans. They don't count people, they aren't a share of U.S. sales, and they say nothing about which style suits a given ear. Supplier counts by category are on VA hearing aid brands.

Invisible hearing aids

Invisible is a seller's word. It isn't a style on NIDCD's page or FDA's types page, and neither invisible nor IIC, the invisible-in-canal shorthand, appears in the CMS labels.

The closest official wording is NIDCD's line that a CIC aid is "nearly hidden in the ear canal." FDA describes ITC and CIC aids as tiny cases that "fit partly or completely into the ear canal." Nearly hidden and unseen are different claims, so judge the claim on the actual device. Three questions turn the word into something you can check:

• Which style is it, in FDA's terms?
• Is this exact model sold over the counter or by prescription?
• If a plan is paying, which billing code would the quote use?

The IIC and CIC models makers sell as invisible, with what they claim and one hospital's listed charges, are on invisible hearing aids.

Hearing aid glasses: Nuance Audio

FDA file K243150, decided January 31, 2025, names "Nuance Audio Hearing Aid Software" from Luxottica Group S.P.A., with the outcome Substantially Equivalent under product code SCR. The file covers software. It calls the Nuance Audio Glasses the "compatible hardware platform", and it doesn't reach other smart glasses. Its summary states use by "individuals 18 years of age or older with perceived mild to moderate hearing loss."

A February 3, 2025 EssilorLuxottica announcement planned sales through its retail network, audiology practices and optical wholesale customers. That was a launch plan, not a current store list. We hold no dated price that includes lenses, so we print none; reported price ranges are on how much hearing aids cost.

CROS and BiCROS hearing aids

CROS stands for contralateral routing of signal and BiCROS for binaural contralateral routing of signal, the terms an Ohio Medicaid rule spells out. Contralateral means the opposite side, so the system carries sound across the head from one side to the other.

The CMS list shows the wording changing. "Hearing aid, cros, behind the ear" and "Hearing aid, bicros, behind the ear" are retired labels. Active ones read "Hearing aid, contralateral routing device, monaural, behind the ear (bte)" and "Hearing aid, contralateral routing system, binaural, bte/bte". A plan document may use either set of words, so search for all of them.

The national Medicaid record is thin. V5221, the binaural behind-the-ear system, has 632 lines from 2 billers, and one of them received 98.3% of the paid dollars. V5240, its dispensing fee, has 12 lines from one biller. Numbers that concentrated say little about a typical bill, so we hold the amounts back.

Coverage wording is on are CROS hearing aids covered by insurance.

Implantable hearing aids: middle ear implants on FDA's record

Implanted devices sit outside the style lists above, and FDA files them as premarket approvals (PMA). Two middle ear implants appear in those records. PMA P090018, decided March 17, 2010, is the Esteem Totally Implantable Hearing System from Envoy Medical Corporation, filed as an active middle ear implant, totally implanted, under product code OAF. PMA P990052, decided August 31, 2000, is the Vibrant Soundbridge system from Med-El, filed as partially implanted, under code MPV.

Each record is the base decision. It names the applicant at that date and doesn't show who sells the device now or whom it suits; later supplements carry the changes.

Medicare's rule reads differently for implants. Its hearing aid definition at 42 CFR 411.15(d) includes devices working by "direct contact with the tympanic membrane or middle ear ossicles", while paragraph (d)(2) lists "Osseointegrated implants in the skull bone" and "Cochlear implants and auditory brainstem implants" as devices not subject to the exclusion. Bone-anchored devices are on BAHA hearing aids, cochlear implants on cochlear implant cost.

Digital hearing aids and technology levels

Two ideas share the word technology. FDA says hearing aids differ by "design, technology used to achieve amplification (analog or digital), and features such as wireless connectivity and software applications." It adds that digital aids are the more common kind.

CMS labels draw a similar split. In the national Medicaid file for 2023-2024 (2024 preliminary), codes labeled digital hold 42,014 lines from 114 billers, codes labeled analog alone hold 0 published lines, and labels reading digitally programmable analog hold 54 lines from 2 billers, and two labels that read digitally programmable with neither word hold 100 lines from 2 billers. These are billing lines from one payer, not a count of aids sold, and an empty row doesn't show that analog aids are gone.

A technology level is something else: a step inside one maker's product line, named by that maker. FDA's types page doesn't sort aids into levels and neither do the CMS labels. We also hold no record that maps one brand's level to another's, so a number or a word like premium only has meaning inside its own brand.

What you can compare is the feature list. FDA names directional microphones, noise reduction, feedback suppression, T-coils, wireless connectivity and direct audio input. Ask the seller, in writing, which of those each level includes and what each level costs.

Insurers can use the term too. Quartz's page for employer-group members sets out its covered manufacturers and styles by technology level, so a level printed on a quote can matter to your plan. Ask yours before you choose.

OTC or prescription: a separate question from style

How an aid may be sold is a different question from where it sits. Under 21 CFR 800.30, air-conduction hearing aids that don't meet the over-the-counter definition or its requirements are prescription hearing aids. The same section prohibits selling an OTC aid to or for anyone younger than 18, and FDA adds: "Hearing aids intended for people younger than 18 years of age are prescription hearing aids."

FDA requires no medical exam or hearing test for a prescription aid, "but your State may require you to visit an audiologist or other licensed professional first." Medicare's rule at 42 CFR 411.15(d) excludes "Hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids", within the scope and exceptions set out there, so the prescription route doesn't change that: see does Medicare cover hearing aids.

A third label overlaps both ideas. 21 CFR 874.3325 classifies the self-fitting air-conduction hearing aid as Class II, with special controls, and points back to the OTC or prescription rules as applicable.

A style name doesn't settle this. Check the route for the exact model, with how to choose a hearing aid and OTC hearing aids.

Hearing loss level is where the OTC route stops. The federal definition covers an aid for a person age 18 or older "to compensate for perceived mild to moderate hearing impairment", so an aid meant for severe hearing loss is a prescription aid, whatever its style.