ModifiedPremera BluecrossPolicy N/A

Cochlear Implant

Medical coverage criteria, documentation, coding, and clinical background for cochlear implant services and components for Premera Bluecross members.

Policy Summary

PayerPremera Bluecross

PolicyCochlear Implant

Policy CodePolicy N/A

Change TypeCoverage expanded to include unilateral hearing loss and minorscoding updates

Effective DateJan. 1, 2026

Next Review DateN/A

Key ActionObtain and submit preoperative audiometric test results and documentation of an appropriately fitted hearing-aid trial showing limited benefit for prior authorization.

SourceLink

POLICY UPDATE CHANGES

Changed policy statement for cochlear implant for individuals with unilateral hearing loss from investigational to medically necessary when criteria are met.

Added coverage criteria for minors under 18 years of age.

Removed HCPCS code L8625 from the policy.

Delete policy effective July 2, 2020 and replaced with InterQual criteria for that period.

9 monthsmin age bilateral

5 yearsmin age SSD/AHL

18 yearsmin age hybrid

70 dBPTA eligibility

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

insufficientunilateral SNHL evidence

expandedcoverage expanded

Coverage Criteria and Policy Statements

Bilateral Hearing Loss - Medical Necessity

Covered when ALL of the following are met

Bilateral CI eligibility: Individual is aged 9 months or older AND has a hearing threshold pure-tone average (PTA) of 70 dB hearing loss or greater at 500 Hz, 1,000 Hz, and 2,000 Hz AND has tried standard hearing aids but had limited or no benefit.age >= 9 months; PTA >= 70 dB at 500,1000,2000 Hz

From policy coverage criteria.

Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL) - Medical Necessity

Covered when ALL of the following are met

SSD/AHL unilateral CI eligibility: Individual is aged 5 years or older AND has limited or no benefit after a minimum one-month trial wearing a Contra Lateral Routing of Signal (CROS) hearing aid or other relevant device AND meets one of the following definitions: single-sided deafness (profound sensorineural hearing loss in one ear and normal or mild sensorineural hearing loss in the other ear) OR asymmetrical sensorineural hearing loss (profound sensorineural hearing loss in one ear and mild to moderately severe sensorineural hearing loss in the other ear with a PTA difference of at least 15 dB between ears).age >= 5 years; CROS trial >= 1 month; SSD >=90 dB or AHL ΔPTA >=15 dB

Non-hybrid FDA-approved cochlear implant device required per policy.

Hybrid Cochlear Implant/Hearing Aid - Medical Necessity

Covered when ALL of the following are met

Hybrid CI eligibility: Individual is aged 18 years or older AND has bilateral severe-to-profound high-frequency sensorineural hearing loss with residual low-frequency hearing sensitivity AND receives limited benefit from appropriately fitted bilateral hearing aids AND meets device-specific audiometric thresholds: low-frequency hearing thresholds no poorer than 60 dB HL up to and including 500 Hz (averaged over 125, 250, 500 Hz) in the ear selected for implantation AND severe to profound mid- to high-frequency hearing loss (average of 2000, 3000, 4000 Hz ≥75 dB HL) in the ear to be implanted AND moderately severe to profound mid- to high-frequency hearing loss (average of 2000,3000,4000 Hz ≥60 dB HL) in the contralateral ear AND preoperative aided CNC word recognition score between 10% and 60% in the ear to be implanted with the contralateral ear equal to or better than that of the ear to be implanted (but not >80% correct).age >=18; low-freq <=60 dB (125-500 Hz avg); mid-high avg >=75 dB (2000,3000,4000 Hz); CNC 10-60%

Hybrid device example: Nucleus Hybrid L24; see FDA-labeled indications for exact ranges.

Replacements and Upgrades

Replacement covered only in specific circumstances; upgrades for aesthetics not covered

Replacement of components: Replacement of internal and/or external components (speech controller or speech processor) may be considered medically necessary when either: (1) the processor is non-functional and cannot be repaired or replaced under the manufacturer's warranty OR (2) the individual's condition has changed such that current components are inadequate and replacement is expected to improve activities of daily living.

Replacement solely to upgrade to advanced technology or for aesthetic improvement (e.g., smaller profile or different form factor) is not medically necessary.

Coverage assessments by indication

Coverage considerations and evidentiary stance noted in the document:

Bilateral sensorineural hearing loss: Evidence from randomized controlled trials and multiple systematic reviews demonstrates improved speech reception, localization, and quality of life with cochlear implants compared with amplification alone, supporting a net health benefit when limited benefit from appropriately fitted amplification is documented.refer to device labels and Medicare thresholds (e.g., ≤40-50% open-set tests; PTA criteria)

Evidence sufficient to determine net health benefit.

Unilateral sensorineural hearing loss (SSD/AHL): Current evidence is limited, heterogeneous, and includes small RCTs and feasibility studies with mixed results; evidence is insufficient to determine a consistent net health benefit, though ongoing postmarketing trials may further inform coverage decisions.N/A

Insufficient evidence for definitive net health benefit at time of review.

Hybrid cochlear implants (high-frequency loss with preserved low-frequency hearing):

Covered indications

Covered when ALL of the following are met for the specified age/indication

General adult bilateral severe-to-profound SNHL: Adults ≥18 years with severe-to-profound bilateral sensorineural hearing loss (commonly defined as PTA ≥70 dB at 500, 1000, and 2000 Hz) who demonstrate limited benefit from appropriately fitted hearing aids as measured by speech-recognition tests (examples: ≤50% correct on HINT sentences in best-aided listening or device/label-specified open-set sentence thresholds).PTA ≥70 dB at 500,1000,2000 Hz; HINT ≤50% (best-aided)

See regulatory and device-specific thresholds for exact test and score cutoffs.

Adult SSD or AHL: Adults with single-sided deafness (SSD, typically ≥90 dB in affected ear) or asymmetrical hearing loss (AHL, PTA difference ≥15 dB) with normal or near-normal contralateral hearing (PTA ≤30 dB HL) who have limited benefit from unilateral amplification defined by monosyllabic CNC word scores ≤50% in ear to be implanted and ≤60% in non-implant ear, and who have had at least a 1-month trial with a CROS or comparable device without subjective benefit.SSD ≥90 dB; contralateral PTA ≤30 dB HL; CNC ear-to-be-implanted ≤50%; non-implant ear ≤60%; CROS trial ≥1 month

Radiologic suitability of cochlea should be confirmed per policy guidance.

Coverage stance highlights

Policy statements and criteria have evolved; notable coverage stances include:

Unilateral hearing loss: Policy status changed: cochlear implantation for individuals with unilateral hearing loss (with or without tinnitus) was historically considered investigational but was changed to medically necessary when criteria are met (interim review approved December 10, 2024).

See policy history for effective dates and rationale.

Children aged 9-12 months: Indications expanded to include children aged 9–12 months with profound bilateral sensorineural hearing loss per policy updates (noted in reinstatement and subsequent reviews).age 9–12 months with profound bilateral SNHL

Policy history documents reinstatement and age expansions.

Hybrid systems: Hybrid cochlear implant/hearing aid systems were initially considered investigational but subsequently included as medically necessary when device criteria are met; evidence and device labeling (e.g., Nucleus Hybrid L24) inform these criteria.

Replacement of internal and/or external cochlear implant components may be considered medically necessary when the processor or other component is nonfunctional and cannot be repaired or replaced under the manufacturer's warranty, or when the individual's clinical condition has changed such that current components are inadequate and replacement is expected to improve activities of daily living. However, upgrades or replacements performed solely to obtain advanced technology or for aesthetic improvements (for example, switching to a smaller profile or a different form factor) are not medically necessary.

Cochlear implantation specifically as a treatment for tinnitus is designated investigational in this policy. The summary of evidence for unilateral hearing loss and related outcomes notes limited and heterogeneous data; consequently, implantation for tinnitus is not established as resulting in net health benefit.

The document does not list unconditional exclusions beyond the stated investigational or not medically necessary items; however, evidence for single-sided deafness (SSD), asymmetric hearing loss (AHL), and hybrid cochlear implants is described as limited and heterogeneous. For SSD/AHL and hybrid systems the available studies are small, of variable design, and long-term outcomes remain uncertain, so the policy characterizes evidence for some of these indications as insufficient to determine a consistent net health benefit.

Historically, cochlear implantation as a treatment for unilateral hearing loss, with or without tinnitus, was considered investigational. Past policy history documents this investigational stance based on literature reviews through 2013 and earlier annual reviews; more recent updates to the policy have revised coverage statements for unilateral hearing loss where specific criteria are met.

This medical policy is intended as a guideline to evaluate medical necessity and does not apply to Medicare Advantage. Providers and members should consult the member benefit booklet or contact customer service to determine coverage for a specific member and plan.

Upgrades of an existing, functioning external cochlear implant system performed solely to achieve aesthetic improvement (for example, a smaller-profile processor or a change from a body-worn processor to a behind-the-ear model) or to obtain next‑generation technology are considered not medically necessary.

For unilateral sensorineural hearing loss (SSD/AHL) and for hybrid cochlear implant systems, the policy summarizes the published literature as limited and heterogeneous. Prospective studies, randomized trials, and systematic reviews show mixed results and uncertainty about long-term outcomes and re‑implantation needs; therefore, the evidence is described as insufficient in some populations to conclude a consistent improvement in net health outcome.

Prior to the policy change effective in early 2025, cochlear implantation for unilateral hearing loss was explicitly considered investigational. History notes reflect that this investigational designation was part of earlier versions of the policy pending more definitive evidence.

Coding and Billing

Covered CPT CodesCPTCovered

69930

Cochlear device implantation, with or without mastoidectomy.

Covered HCPCS CodesHCPCSCovered

L8614	Cochlear device, includes all internal and external components.
L8619	Cochlear implant external speech processor and controller, integrated system, replacement.

Referenced coverage thresholds and examples (not explicit billing codes)mixed

No codes listed

Coding history and affected codesmixed

L8625	HCPCS code (removed)
L8615	HCPCS code (removed earlier)
L8627	HCPCS code (removed)
L8628	HCPCS code (changed from L8328 to L8628)
92601-92633	CPT codes related to evaluation/rehabilitation (many removed over time)

inv-20: Pure-tone average (PTA) eligibility — PTA ≥70 dB at 500, 1000, and 2000 Hz for bilateral severe-to-profound hearing loss; other device-specific thresholds (e.g., hybrid device...)

Bilateral severe-to-profound PTA thresholdPTA ≥70 dB HL at 500, 1,000, and 2,000 Hz required for bilateral cochlear implant candidacy (individuals aged ≥9 months).

Hybrid device low-frequency requirementFor hybrid cochlear implant candidacy, low-frequency thresholds no poorer than 60 dB HL averaged over 125, 250, and 500 Hz in the ear selected for implantation.

Hybrid device mid/high-frequency requirementHybrid candidacy requires severe-to-profound mid-to-high-frequency loss: average at 2,000, 3,000, and 4,000 Hz ≥75 dB HL in the ear to be implanted (contralateral ear ≥60 dB HL average at those frequencies).

inv-21: Audiometric and speech-recognition thresholds — Examples include ≤50% HINT sentences (device labels), ≤40% open-set sentence tests (Medicare definition), PTA thresholds >70 dB or ≥90 dB...

Provider Requirements, Documentation, and Authorization

Prior Authorization

Prior Authorization Permitted

Prior authorization may be required by the health carrier for cochlear implantation and related hearing instruments. When prior authorization is requested, submit complete preoperative audiology documentation and evidence of a documented trial of appropriately fitted hearing aids or relevant devices showing limited or no benefit. Verify member benefits and any prior authorization requirements with the member's plan before scheduling services.

Prior authorization: may be required per Washington mandate and payer policy
Verify benefits and any prior authorization requirements with member contract or member services before proceeding

Documentation Required

Prior authorization requires hearing-aid trial and test-score documentation

Prior authorization requests must include documentation of an appropriately fitted hearing-aid trial and measured test scores demonstrating limited benefit from amplification. For adults this typically includes best-aided speech recognition scores (examples: CNC, HINT) showing limited benefit per policy thresholds; for children include age-appropriate speech tests (e.g., MLNT, LNT, PBK, HINT for Children) and developmental/functional auditory measures (e.g., IT-MAIS/MAIS) when applicable.

Definitions and Terms

Cochlear implants bypass nonfunctional cochlear transducer cells to provide direct electrical stimulation to the auditory nerve via internal and external components. They are intended for individuals with severe-to-profound sensorineural hearing loss who obtain limited benefit from appropriately fitted hearing aids, and post‑implant auditory rehabilitation is typically needed to maximize functional outcomes.

inv-40: Profound hearing loss — PTA of 90 dB HL or greater at 500, 1000, 2000 and 4000 Hz.

Definition of profound hearing lossProfound hearing loss: PTA of 90 dB HL or greater at 500, 1,000, 2,000 and 4,000 Hz.

Context of useThis definition is used for determining candidacy in SSD/AHL and pediatric profound bilateral SNHL coverage statements.

Relation to pediatricsChildren aged 9–24 months with profound bilateral SNHL (≥90 dB) meet criteria for consideration after required hearing-aid trials unless ossification precludes trial.

inv-41: Severe hearing loss — PTA of 70 to 90 dB (document notes severe as 70 dB or greater for eligibility).

Policy Summary

PayerPremera Bluecross

PolicyCochlear Implant

Policy CodePolicy N/A

Change TypeCoverage expanded to include unilateral hearing loss and minorscoding updates

Effective DateJan. 1, 2026

Next Review DateN/A

Key ActionObtain and submit preoperative audiometric test results and documentation of an appropriately fitted hearing-aid trial showing limited benefit for prior authorization.

SourceLink

On This Page

Prospective and retrospective studies and clinical input suggest improved speech recognition over hearing aids alone and potential preservation of low-frequency hearing with shallower insertion depths, but long-term outcomes and re-implantation data are limited; evidence is currently insufficient to determine net health benefit definitively.

2016 clinical input supports use in this population; further data needed.

Pediatric profound bilateral SNHL: Children meeting device/age-specific regulatory criteria (including infants aged 9–24 months with profound bilateral SNHL or older children per manufacturer labeling) who have used appropriately fitted hearing aids for required trial durations (e.g., ≥6 months for ages 2–17 years; ≥3 months for 12–23 months when applicable) and demonstrate lack of benefit by age-appropriate measures (developmental auditory milestones, IT-MAIS/MAIS, MLNT/LNT/PBK or HINT thresholds as specified).Profound bilateral SNHL often defined as PTA >90 dB; hearing-aid trials per age band

See regulatory summaries for age- and test-specific cutoffs and exceptions (e.g., ossification).

Hybrid implant candidacy: Adults (≥18 years) who meet hybrid device–specific audiometric and speech criteria: low-frequency thresholds no poorer than 60 dB HL up to and including 500 Hz (avg 125,250,500 Hz) in the ear selected, mid-to-high-frequency average ≥75 dB HL at 2000,3000,4000 Hz in the ear to be implanted, contralateral mid-high-frequency average ≥60 dB HL, and preoperative aided CNC word recognition score 10%–60% in the ear to be implanted with contralateral ear equal or better (and not more than 80% correct).Low-freq avg ≤60 dB; mid-high avg ≥75 dB; CNC 10–60%

Device example: Nucleus Hybrid L24 with FDA-labeled indications.

Clinical input (2016) and FDA approvals influenced policy evolution.

Adult speech-recognition/aid-benefit threshold (HINT)Limited benefit from appropriately fit hearing aids defined as ≤50% correct on HINT sentences in quiet or noise (best-sided listening) for adults with bilateral severe-to-profound SNHL.

Medicare open-set sentence thresholdMedicare defines limited benefit as ≤40% correct on tape-recorded open-set sentence cognition tests in the best-aided condition for coverage determinations.

CNC/monosyllabic thresholds for SSD/AHLFor SSD/AHL candidacy, limited benefit may be demonstrated by monosyllabic CNC scores ≤50% in the ear to be implanted and ≤60% in the non-implant ear when tested in quiet.

inv-22: Audiometric and speech thresholds — Multiple thresholds described: contralateral PTA ≤30 dB HL; implanted-ear PTA criteria ranging from >40 dB to ≥90 dB depending on indicat...

Contralateral ear normal/hearing thresholdNormal or near-normal hearing in the contralateral ear defined as PTA ≤30 dB HL at 500, 1,000, 2,000 and 4,000 Hz (applies to SSD/AHL candidacy).

Implanted-ear PTA rangesImplanted-ear PTA criteria vary by indication: examples include >40 dB HL at low frequencies up to severe-to-profound ranges (≥70 dB or ≥90 dB) depending on age and device-specific labeling.

Pediatric implanted-ear thresholdsChildren with profound bilateral SNHL often defined as PTA ≥90 dB HL; some pediatric SSD/AHL criteria reference implanted-ear PTA >80 dB HL at 500–4,000 Hz for candidacy.

Adults: documented trial of appropriately fitted hearing aids with best-aided speech recognition scores (e.g., CNC, HINT) per policy thresholds
Children: documented hearing-aid trials of required duration and age-appropriate test scores (e.g., MLNT, LNT, PBK, HINT for Children, IT-MAIS/MAIS)

Documentation Required

Preoperative audiology documentation for authorization

Preoperative audiology records must be submitted to support authorization decisions. Include pure-tone thresholds (PTA at specified frequencies), ear-specific aided and unaided speech recognition scores, sound-field measures when required, and documentation of hearing-aid fitting and usage.

Pure-tone averages (report thresholds at 250, 500, 1000, 2000, 4000 Hz as applicable)
Aided and unaided speech recognition scores for each ear (e.g., CNC, HINT, PBK, MLNT, LNT)
Sound-field test results (when applicable) and device manufacturer/model
Medical clearance for minors within preceding 6 months (otolaryngologist or licensed physician as specified)

Denial Risk

Denial Risk — Insufficient benefit or missing test thresholds

Failure to demonstrate limited benefit from amplification per stated thresholds or to provide required audiometric and speech test documentation may result in denial of coverage.

Failure to meet amplification benefit thresholds (e.g., best-aided sentence/word scores above specified cutoffs) may be a basis for denial
Failure to meet audiometric or speech test thresholds (e.g., PTA, CNC, HINT, MLNT/LNT/PBK criteria) will risk non-coverage

Documentation Required

Required prior hearing-aid trial and test results

Required prior hearing-aid trial durations and documented lack of benefit vary by age and indication. Ensure trial periods and evidence conform to policy-defined intervals and tests before submitting for authorization.

Children 2–17 years: ≥6 months of appropriately fitted hearing aid use (or 3–6 months when stated by device guidance)
Infants 12–23 months: ≥3 months hearing-aid trial where feasible
Adults and SSD/AHL candidates: at least 1 month trial with CROS or relevant device for single-sided deafness when required

Documentation Required

Hearing aid trial requirement

Hearing-aid trial requirement: document that appropriately fitted standard hearing aids were tried for the required duration and that the member experienced limited or no benefit. For SSD/AHL candidates, document at least the minimum trial with CROS or other relevant devices.

Document hearing-aid fitting parameters and dates of trial
Document subjective and objective measures of limited benefit (speech scores, lack of developmental progress, functional reports)

Documentation Required

Hearing-aid trial before implantation

A 3–6 month hearing-aid trial is typically required before implantation for pediatrics when ossification does not preclude a trial; trials shorter than policy-specified intervals must be supported by clinical rationale in the record.

If ossification or other clinical factors preclude a standard trial, include supporting radiologic or clinical documentation
For children, lack of progress in auditory development over 3–6 months may substitute for formal trial outcomes

Documentation Required

Hearing aid trial requirements

Hearing-aid trial requirements differ by age and device type. Confirm the specific trial duration and required test instruments for the member's age and indication and include those results in the request.

Hybrid device candidates (adults ≥18 years): preoperative CNC scores between 10%–60% in the ear to be implanted and contralateral ear not more than 80%
Children: MLNT/LNT/PBK thresholds and developmental auditory measures as specified by age

Step Therapy

Step therapy

No additional step therapy requirements are specified here beyond the documented hearing-aid or relevant device trials required for medical necessity determination. Providers should still verify whether a member's benefit plan imposes any step or utilization controls.

Step therapy: none specified in policy — prior trials of hearing aids count as required steps
Always confirm plan-specific utilization controls with member services

Note

Verify prior authorization and member benefits

Benefit verification is the provider's responsibility. Coverage is subject to member benefit plan limits and conditions; failure to verify benefits or prior authorization requirements may lead to claim denial or patient liability.

Consult the member benefit booklet or contact customer/member service to confirm coverage, frequency limits, and whether state-mandated provisions apply to the member (fully insured vs self-funded)
Confirm prior authorization timelines and required documentation before scheduling

Severe hearing loss definitionSevere hearing loss: PTA of 70 to 90 dB; policy uses PTA ≥70 dB at 500, 1,000, and 2,000 Hz as eligibility threshold for bilateral implantation.

Adult bilateral candidacy thresholdAdults with severe-to-profound bilateral SNHL are described as having ≥70 dB PTA at 500, 1,000, and 2,000 Hz for candidacy considerations.

Severity scale referenceThe policy distinguishes severe (70–90 dB) and profound (≥90 dB) ranges for application across device indications.

inv-42: Single-sided deafness (SSD) — Profound sensorineural hearing loss in one ear and normal hearing or mild sensorineural hearing loss in the other ear.

SSD definitionSingle-sided deafness (SSD): profound sensorineural hearing loss in one ear and normal hearing or mild sensorineural hearing loss in the other ear.

Numeric threshold for SSDPolicy references SSD as ≥90 dB PTA in the affected ear with contralateral ear PTA up to 15 dB (normal) or ≤30 dB (mild) depending on context.

Trial requirement for SSDAt least a 1-month trial wearing a CROS or other relevant device with no subjective benefit is required before unilateral implantation for SSD.

inv-43: Asymmetrical sensorineural hearing loss (AHL) — Profound sensorineural hearing loss in one ear and mild to moderately severe sensorineural hearing loss in the other ear, with a PTA diff...

AHL definitionAsymmetrical sensorineural hearing loss (AHL): profound sensorineural hearing loss in one ear and mild to moderately severe sensorineural hearing loss in the other ear with a PTA difference of at least 15 dB between ears.

PTA difference criterionPolicy requires a PTA difference (Δ) of ≥15 dB between ears to define AHL for candidacy determinations.

Functional access requirementInsufficient functional access to sound in the ear to be implanted must be demonstrated by aided speech perception testing for pediatric AHL candidacy (5–18 years age band).

inv-44: cochlear implant — Cochlear implant: a device providing direct electrical stimulation to the auditory nerve to bypass nonfunctional cochlear transducer cell...

Cochlear implant definitionCochlear implant: a device providing direct electrical stimulation to the auditory nerve, bypassing nonfunctional cochlear transducer cells, consisting of internal and external components.

ComponentsExternal components: microphone, external sound processor, external transmitter; internal components: receiver implanted in temporal bone and electrode array into the cochlea.

PurposeUsed to treat severe-to-profound sensorineural hearing loss in individuals who receive limited benefit from amplification with hearing aids.

inv-45: hybrid cochlear implant — Hybrid cochlear implant: a system combining a cochlear implant electrode array with preserved residual low-frequency hearing aided by an ...

Hybrid cochlear implant definitionHybrid cochlear implant: a system combining a cochlear implant electrode array with preserved residual low-frequency hearing aided by an integrated hearing-aid function in the external sound processor (example: Nucleus Hybrid L24).

Indicated populationFDA-labeled for unilateral use in individuals aged ≥18 years with residual low-frequency hearing and severe-to-profound high-frequency SNHL; expanded approval later included SSD/AHL in ages ≥5 years (per PMA supplement).

Device characteristicsHybrid systems use a shorter electrode array to preserve low-frequency hearing while electrically stimulating high-frequency regions; preoperative aided CNC 10–60% in ear to be implanted is specified for candidacy.

inv-46: PTA — Pure tone average of thresholds at specified frequencies.

PTA termPTA (pure tone average): the average of hearing thresholds at specified frequencies, commonly 500, 1,000, and 2,000 Hz (or other frequency sets as noted).

Use in policyPTA thresholds are used throughout the policy to define severity categories (normal, mild, moderate, severe, profound) and candidacy cutoffs.

Frequency setsDifferent policy statements reference PTA across frequency sets depending on indication (e.g., 500/1,000/2,000 Hz for bilateral eligibility; 500/1,000/2,000/4,000 Hz for contralateral ear normality).

inv-47: CNC — Consonant-Nucleus-Consonant word recognition test.

CNC definitionCNC: Consonant-Nucleus-Consonant word recognition test used for monosyllabic word recognition assessment; cited as a required aided preoperative measure for hybrid and SSD/AHL candidacy.

CNC role in hybrid candidacyHybrid device labeling requires preoperative aided CNC word recognition score between 10% and 60% in the ear to be implanted; contralateral ear equal or better but ≤80% correct.

CNC role in SSD/AHLCNC monosyllabic thresholds (e.g., ≤50% in ear to be implanted) are referenced as part of limited-benefit demonstrations for unilateral indications.

inv-48: SSD — Single-sided deafness (≥90 dB).

SSD numeric threshold (policy)SSD: single-sided deafness characterized by an affected-ear PTA ≥90 dB (profound) in policy definitions and regulatory summaries.

Clinical trial/regulatory notePolicy references regulatory summaries where SSD is described as PTA ≥90 dB for candidacy and where CROS trial requirement applies before implantation.

Related requirementFor SSD, contralateral ear must have normal or near-normal hearing (PTA ≤30 dB HL) and at least a 1-month CROS trial with no subjective benefit.

inv-49: AHL — Asymmetric hearing loss (Δ15 dB PTA).

AHL numeric deltaAHL defined as asymmetric hearing loss with a PTA difference (Δ) of at least 15 dB between ears for policy consideration.

Severity pairingAHL involves profound loss in one ear and mild to moderately severe loss in the other (policy notes mild to moderately severe contralateral PTA 31–55 dB HL).

Implication for candidacyPolicy requires demonstration of insufficient functional access to sound in the ear to be implanted by aided speech perception testing for AHL candidacy.

inv-50: Hybrid cochlear implant/hearing aid system — Hybrid cochlear implant/hearing aid system: a combined device referenced in policy statements regarding investigational or medically nece...

Combined system descriptionHybrid cochlear implant/hearing aid system: a combined device that integrates a short electrode array with an external sound processor that provides acoustic amplification for low frequencies and electrical stimulation for high frequencies.

Policy referencesThe policy references hybrid systems (e.g., Nucleus Hybrid L24) in coverage statements and regulatory summaries; prior status evolved from investigational to medically necessary when criteria are met.

Clinical considerationsHybrid systems aim to preserve residual low-frequency hearing; long-term outcomes and re-implantation data are limited per policy evidence summaries.