Currentsierra health and lifePolicy 2026T0070HH

Cochlear Implants

Defines medical necessity, coverage considerations, coding, and benefit distinctions for cochlear implantation (non-hybrid and hybrid) across UnitedHealthcare commercial and individual exchange plans; affects providers requesting authorization and billing for cochlear implants and related components.

Policy Summary

Payersierra health and life

PolicyCochlear Implants

Policy CodePolicy 2026T0070HH

Change TypeTemplate updateshared policy creation

Effective DateJan 1, 2026

Next Review Date

Key ActionRequest prior authorization using the listed CPT/HCPCS codes and reference InterQual CP: Procedures, Cochlear Implantation for medical necessity.

SourceLink

POLICY UPDATE CHANGES

Created shared policy version to support application to Oxford plan membership.

Template update noted in summary of changes.

69930CPT code listed

L8614-L8628,V5273HCPCS codes listed

≥18Adult age threshold

≥6 moPediatric bilateral

≥9 moPediatric single-sided

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Coverage Criteria for Cochlear Implants

Covered Indications

Covered when meeting referenced InterQual medical necessity criteria and applicable age/indication thresholds.

Non-hybrid cochlear implantation (adults): Non-hybrid cochlear implantation is proven and medically necessary under certain circumstances for bilateral sensorineural and/or for single-sided or asymmetric sensorineural hearing loss in adults ages 18 and older; refer to InterQual CP: Procedures, Cochlear Implantation for medical necessity clinical coverage criteria.age >= 18

See InterQual CP: Procedures, Cochlear Implantation for detailed clinical criteria.

Non-hybrid cochlear implantation (children): Non-hybrid cochlear implantation is proven and medically necessary under certain circumstances for bilateral sensorineural hearing loss in children ages 6 months or older and for single-sided or asymmetric sensorineural hearing loss in children ages 9 months or older; refer to InterQual CP: Procedures, Cochlear Implantation (Pediatric) for medical necessity clinical coverage criteria.age >= 6 months (bilateral) or >= 9 months (single-sided)

Non-hybrid cochlear implantation for bilateral SNHL in children younger than 6 months and for single-sided/asymmetric SNHL in children younger than 9 months is considered experimental/investigational due to lack of FDA approval.

Hybrid cochlear implantation (adults): Hybrid cochlear implantation is proven and medically necessary under certain circumstances for sensorineural hearing loss in adults ages 18 and older; refer to InterQual CP: Procedures, Cochlear Implantation for medical necessity clinical coverage criteria.age >= 18

Refer to InterQual for specifics.

Non-hybrid cochlear implantation is covered when the member meets the referenced InterQual® medical necessity criteria and the applicable age and indication thresholds. For adults (age ≥ 18), non-hybrid cochlear implantation may be medically necessary for bilateral sensorineural hearing loss or for single-sided/asymmetric sensorineural hearing loss; refer to InterQual CP: Procedures, Cochlear Implantation for clinical details. For children, non-hybrid cochlear implantation is medically necessary for bilateral SNHL in infants aged ≥ 6 months and for single-sided or asymmetric SNHL in children aged ≥ 9 months, per InterQual pediatric criteria.

Cochlear implantation in pediatric patients younger than the FDA-approved ages is considered experimental or investigational. Specifically, implantation for bilateral SNHL in children younger than 6 months and for single-sided or asymmetric SNHL in children younger than 9 months is not covered because these uses lack FDA approval; clinicians and providers should consult the InterQual CP: Procedures, Cochlear Implantation (Pediatric) when preparing authorization requests and documenting medical necessity.

Coding and Age Thresholds

Covered CPT Codes (reference)CPT

69930

Cochlear device implantation, with or without mastoidectomy

HCPCS Codes for implant components/external devicesHCPCS

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

Pediatric age thresholds — Cochlear implantation

Bilateral SNHL (pediatric)Coverage allowed for children age ≥6 months for non-hybrid cochlear implantation

Single-sided/asymmetric SNHL (pediatric)Coverage allowed for children age ≥9 months for non-hybrid cochlear implantation

Under-age exclusion (pediatric)Non-hybrid cochlear implantation is experimental/investigational for bilateral SNHL <6 months and single-sided/asymmetric SNHL <9 months due to lack of FDA approval

Adult age threshold — Cochlear implantation

Adult age thresholdAdults age ≥18 years for non-hybrid cochlear implantation for bilateral and/or single-sided/asymmetric SNHL

Hybrid implantation (adult)

Provider Actions, Authorization, and Documentation

Prior Authorization

Prior Authorization and Coding

Authorization and coding: Coverage for cochlear implantation and related services is subject to medical necessity criteria as referenced in the InterQual® CP: Procedures, Cochlear Implantation (adult and pediatric versions where applicable). Prior authorization may be required; providers should check member-specific benefit documents and submit required clinical documentation consistent with InterQual criteria for review.

InterQual® CP: Procedures, Cochlear Implantation (adult and pediatric)

Billing Rule

Durable Medical Equipment (DME) Pathway for External Components

DME pathway for external components: External components of cochlear implants (speech processor, microphone, transmitter coil) are considered Durable Medical Equipment (DME) and are administered under the DME benefit. Providers must reference the member's specific benefit plan to determine DME coverage for repair, replacement, or purchase of external components and follow the Medical Policy titled Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements for benefit rules and billing.

Background

Sensorineural hearing loss (SNHL) results from damage to the inner ear (cochlea) or the auditory nerve pathways and is typically permanent. Cochlear implantation—both non-hybrid and hybrid devices—is an established treatment option for selected patients with SNHL when conservative measures are insufficient. Coverage decisions for cochlear implantation rely on meeting InterQual clinical criteria and applicable plan benefits; note that external components (speech processors, microphones, transmitter coils) are handled under the DME benefit and that frequency modulated (FM) systems are excluded from coverage as they are not considered a covered health care service.

Definitions

Sensorineural Hearing Loss (SNHL)

DefinitionSensorineural Hearing Loss (SNHL): damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain

Typical courseMost of the time SNHL cannot be medically or surgically corrected and is the most common type of permanent hearing loss

Source attributionDefinition per American Speech-Language-Hearing Association (ASHA) as cited in policy

Revision History & Policy Changes

2026-01-01template_updateLatest

Template update and creation of shared policy version to support application to Oxford plan membership; archived previous policy versions 2025T0070GG and ENT 004.38.