CurrentColorado Rocky Mountain Health PlansPolicy 2026T0070II

Cochlear Implants

Defines UnitedHealthcare commercial and individual exchange medical policy coverage positions for cochlear implants (non-hybrid and hybrid) including age-based indications, pediatric limits, benefit considerations for external vs implantable components, exclusions (FM systems), and references to InterQual clinical criteria and member-specific benefit determination.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCochlear Implants

Policy CodePolicy 2026T0070II

Change TypeRoutine review; no coverage changes

Effective DateJun 1, 2026

Next Review Date

Key ActionAssess medical necessity using InterQual CP: Procedures, Cochlear Implantation and ensure medical records documentation supports the criteria; reference member-specific benefit plan for component benefit applicability.

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines.

Adults & specified pediatricsCovered Indications

FM systemsExplicit Exclusion

InterQualExternal Criteria Source

Coverage Summary

Scope: This policy defines UnitedHealthcare commercial and individual exchange positions for cochlear implants (non-hybrid and hybrid), specifying age-based indications for adults and children, pediatric limits, exclusions, and benefit considerations for external versus implantable components. Medical necessity determinations are tied to InterQual clinical criteria and member-specific benefit documents.

Background: Cochlear implantation is considered proven and medically necessary under certain circumstances for adults and for pediatric patients who meet the specified age cutoffs and InterQual clinical criteria; FDA approvals and member-specific benefit documents are referenced for applicability.

Medical Necessity Criteria

Non-hybrid cochlear implantation — Adults

Covered when ALL of the following are met:

ALL of the following

Patient is an adult age 18 years or older
Sensorineural Hearing Loss (SNHL) that meets medical necessity clinical coverage criteria per InterQual CP: Procedures, Cochlear Implantation

Non-hybrid cochlear implantation — Children (pediatric)

Covered when ALL of the following are met:

ALL of the following

For bilateral Sensorineural Hearing Loss: child is 6 months of age or older
For single-sided or asymmetric Sensorineural Hearing Loss: child is 9 months of age or older
Clinical criteria per InterQual CP: Procedures, Cochlear Implantation (Pediatric) are met

Hybrid cochlear implantation — Adults

Covered when ALL of the following are met:

ALL of the following

Patient is an adult age 18 years or older
Sensorineural Hearing Loss meeting InterQual CP: Procedures, Cochlear Implantation criteria for hybrid implants

Pediatric Not Covered (Experimental/Investigational)

Non-hybrid cochlear implantation — Pediatric not covered age groups

Not covered (considered experimental/investigational) when ANY of the following are true:

ANY of the following

Child with bilateral Sensorineural Hearing Loss younger than 6 months
Child with single-sided or asymmetric Sensorineural Hearing Loss younger than 9 months
Lack of FDA approval for those age groups

Note that Frequency Modulated (FM) systems are excluded from coverage because they are not integral to cochlear implant function and do not meet the definition of a covered health care service. For medical necessity determinations, use the InterQual CP: Procedures, Cochlear Implantation criteria; FDA approvals are referenced for informational purposes but FDA approval alone is not a basis for coverage, and member-specific benefit documents must be consulted.

Coding

Procedure CPTCPT

69930

Cochlear device implantation, with or without mastoidectomy.

HCPCS - Implant external component replacementsHCPCS

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

Documentation Required

Use InterQual criteria for medical necessity

Medical necessity for cochlear implantation must be assessed using the InterQual CP: Procedures, Cochlear Implantation criteria for both adult and pediatric populations. Medical records documentation may be required to verify that the member meets the InterQual clinical criteria.

Billing Rule

Benefit determination by component

Benefit determination is done by component: external components (speech processor, microphone, transmitter coil, headset/headpiece, transmitting coil, transmitter cable, external speech processor/controller components, assistive listening device) are considered under the DME benefit; implantable components (the implanted device and implantation procedure) are considered under the medical-surgical benefit. Reference the member-specific benefit plan document to determine applicability and any limits for DME versus medical-surgical benefits. Affected example codes include: L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273, and 69930.

Codes: L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273, 69930

Documentation Required

Aural rehabilitation billing

Cochlear implant monitoring (remapping/reprogramming) and post-implant rehabilitation are usually billed as outpatient aural rehabilitation. Check the member-specific benefit plan document for any applicable limits on outpatient aural rehabilitation services.

Denial Risk

FM systems excluded

Frequency modulated (FM) systems are excluded from coverage and are not considered a covered health care service. FM systems are not considered integral to the function of the cochlear implant and therefore will not be covered.

Background

Cochlear implants (non-hybrid and hybrid) are proven and medically necessary under certain circumstances when the patient meets the InterQual CP: Procedures, Cochlear Implantation clinical criteria and applicable age-based indications. Pediatric non-hybrid implantation has specified age thresholds and is considered experimental/investigational for age groups lacking FDA approval. External components (speech processor, microphone, transmitter coil) are considered under the DME benefit, while implantable components are considered under the medical-surgical benefit; the member-specific benefit plan determines applicability and limits.

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; it is typically permanent and not correctable medically or surgically.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCochlear Implants

Policy CodePolicy 2026T0070II

Change TypeRoutine review; no coverage changes

Effective DateJun 1, 2026

Next Review Date

On This Page

OpenPayer

Cochlear Implants

Coverage Summary

Medical Necessity Criteria

Pediatric Not Covered (Experimental/Investigational)

Coding

Provider Actions

Background

Revision History