CurrentColorado Rocky Mountain Health PlansPolicy 2026T0070II

Cochlear Implants

Defines UnitedHealthcare commercial and individual exchange coverage positions for non-hybrid and hybrid cochlear implantation (adult and pediatric), references InterQual clinical criteria for medical necessity, and describes benefit considerations, coding, FDA info, and exclusions such as FM systems.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCochlear Implants

Policy CodePolicy 2026T0070II

Change TypeRoutine review — no coverage change

Effective DateJun 1, 2026

Next Review Date

Key ActionProviders must reference and document that the member meets InterQual CP criteria (adult or pediatric as applicable) and include medical records documentation to support medical necessity; member-specific benefit plan governs final coverage determination.

POLICY UPDATE CHANGES

06/01/2026: Routine review; no change to coverage guidelines; archived previous policy version 2026T0070HH.

Adults & PediatricsCovered Indications

FM systemsExplicitly Excluded

InterQualUses External Criteria

Coverage Summary

Scope: Defines UnitedHealthcare commercial and individual exchange coverage positions for non-hybrid and hybrid cochlear implantation for adults and children, references InterQual clinical criteria for medical necessity, and describes benefit considerations, coding, FDA information, and exclusions such as FM systems.

Coverage stance (mixed): Non-hybrid and hybrid cochlear implants are covered under specified clinical circumstances; InterQual CP: Procedures, Cochlear Implantation (adult and pediatric) is the authoritative source for specific numeric/functional thresholds and should be used to determine medical necessity. FDA approval status is referenced for informational purposes and may inform investigational determinations, but member-specific benefit plans govern the final coverage decision.

Medical Necessity Criteria (InterQual referenced)

Non-hybrid Cochlear Implantation - Adults

Non-hybrid cochlear implantation is proven and medically necessary under certain circumstances for adults ages 18 and older; refer to InterQual CP: Procedures, Cochlear Implantation for medical necessity criteria.

ALL of the following

Patient is age 18 years or older
Diagnosis: bilateral sensorineural hearing loss and/or single-sided or asymmetric sensorineural hearing loss
Meets InterQual CP: Procedures, Cochlear Implantation clinical criteria

Non-hybrid Cochlear Implantation - Pediatrics

Non-hybrid cochlear implantation is proven and medically necessary under certain circumstances for children per age thresholds; refer to InterQual CP: Procedures, Cochlear Implantation (Pediatric).

Covered pediatric indications by age

Bilateral SNHL
- Patient is a child age 6 months or older
- Diagnosis: bilateral sensorineural hearing loss
- Meets InterQual Pediatric Cochlear Implantation criteria
Single-sided or asymmetric SNHL
- Patient is a child age 9 months or older
- Diagnosis: single-sided or asymmetric sensorineural hearing loss

Hybrid Cochlear Implantation - Adults

Hybrid cochlear implantation coverage for adults.

ALL of the following

Patient is age 18 years or older
Diagnosis: sensorineural hearing loss
Meets InterQual CP: Procedures, Cochlear Implantation clinical criteria for hybrid implants

Experimental / Investigational

Situations considered experimental or investigational in this policy

ANY of the following

Non-hybrid cochlear implantation for bilateral SNHL in children younger than 6 months (experimental/investigational)
Non-hybrid cochlear implantation for single-sided or asymmetric SNHL in children younger than 9 months (experimental/investigational)

Coding

Procedure CPTCPT

69930

Cochlear device implantation, with or without mastoidectomy

HCPCS - Cochlear device and componentsHCPCS

L8614	Cochlear device, includes all internal and external components
L8615	Headset/headpiece for use with cochlear implant device, replacement
L8616	Microphone for use with cochlear implant device, replacement
L8617	Transmitting coil for use with cochlear implant device, replacement
L8618	Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
L8619	Cochlear implant, external speech processor and controller, integrated system, replacement
L8627	Cochlear implant, external speech processor, component, replacement
L8628	Cochlear implant, external controller component, replacement
V5273	Assistive listening device, for use with cochlear implant

Provider Actions & Billing Guidance

Documentation Required

Use InterQual criteria and medical records for coverage determination

Providers must reference and document that the member meets the applicable InterQual CP: Procedures, Cochlear Implantation clinical criteria (adult or pediatric as applicable) and include supporting medical records documentation to establish medical necessity. Medical records may be required for review but do not guarantee coverage; the member-specific benefit plan document governs the final coverage determination.

Affected codes: 69930

Billing Rule

Benefit determination split between medical-surgical and DME

Implantable cochlear components are considered part of the medical-surgical benefit, while external components (for example, speech processor, microphone, and transmitter coil) are considered under the durable medical equipment (DME) benefit. The member-specific benefit plan document must be referenced to determine DME coverage, repair, or replacement limits.

HCPCS: L8614
HCPCS: L8615
HCPCS: L8616
HCPCS: L8617
HCPCS: L8618
HCPCS: L8619
HCPCS: L8627
HCPCS: L8628
HCPCS: V5273

Billing Rule

Aural rehabilitation billing

Remapping/reprogramming (monitoring) of the cochlear implant and rehabilitation following implantation are usually billed as outpatient aural rehabilitation therapy. These services are subject to the member's outpatient rehabilitation therapy benefits and any applicable limits in the member-specific benefit plan.

Denial Risk

FM systems excluded from coverage

Frequency modulated (FM) systems are excluded from coverage because they do not meet the definition of a covered health care service and are not integral to cochlear implant function. Claims for FM systems may be denied.

Background & Definitions

This policy distinguishes non-hybrid and hybrid cochlear implants. Non-hybrid implants are addressed separately for adults and children and are covered when InterQual clinical criteria are met. Hybrid cochlear implantation is covered for adults meeting InterQual criteria.

Pediatric age-based restrictions: non-hybrid cochlear implantation for bilateral SNHL is considered medically necessary for children aged 6 months or older, and for single-sided or asymmetric SNHL for children aged 9 months or older. Non-hybrid implantation in children younger than these age thresholds is considered experimental or investigational due to lack of FDA approval.

FDA role: FDA approval status is provided for informational use and informs investigational determinations (lack of FDA approval cited as reason for investigational classification in younger pediatric age groups), but FDA approval alone is not a basis for coverage.

Final coverage determination: The member specific benefit plan document governs final coverage decisions; medical records and documentation showing the member meets InterQual criteria may be required to support medical necessity.

Term	Definition
Sensorineural Hearing Loss (SNHL)	Occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain; most of the time, SNHL cannot be medically or surgically corrected.