Cochlear Implants and Auditory Brainstem Implants (CPB 0013, reviewed 2026-03-05)
Aetna considers unilateral or bilateral cochlear implantation medically necessary for adults 18 and older with bilateral, pre- or post-linguistic, sensorineural, moderate-to-profound hearing impairment who have a pure-tone average of 60 dB HL or greater at 500, 1000 and 2000 Hz and limited benefit from appropriately fitted hearing aids. It considers implantation medically necessary for infants and children with severe to profound bilateral sensorineural hearing loss (pure-tone average of 70 dB HL or greater) who have limited benefit from binaural hearing aids, and for individuals aged 1 year and older with single-sided deafness or asymmetric hearing loss who meet the stated criteria. Hybrid cochlear implants such as the Nucleus Hybrid L24 are considered medically necessary for adults 18 and older with the stated high-frequency hearing loss pattern. An auditory brainstem implant is considered medically necessary for members 12 years of age or older who have lost both auditory nerves due to disease or bilateral surgical removal of auditory nerve tumors. Cochlear implantation for auditory dyssynchrony, auditory neuropathy spectrum disorder, tinnitus and all other indications not meeting these criteria is considered experimental, investigational or unproven.