ICD-10 H90.42 is officially defined as "Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side." code H90.42 is referenced in 12 tracked payer policy changes from Independence Blue Cross, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H90.42 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross expanded cochlear implant coverage to now include single-sided deafness (unilateral hearing loss) and asymmetric hearing loss in patients age 5+, while removing restrictive replacement criteria and reclassifying SSD/AHL from experimental to medically necessary. This significantly broadens coverage eligibility and simplifies documentation requirements for replacement components.
Independence Blue Cross reissued medical policy 11.01.06j on bone-anchored (osseointegrated) hearing aids and implantable middle ear hearing aids, effective 05/27/2026. Five new CPT codes (0951T, 0952T, 0953T, 0954T, 0955T) were added to the Experimental/Investigational section as of 07/01/2025, meaning these codes are not covered. The policy clarifies that bone-anchored hearing aids remain medically necessary for qualifying patients with conductive/mixed hearing loss or single-sided sensorineural deafness, while implantable middle ear hearing aids remain experimental and non-covered.
Independence Blue Cross reissued Policy 11.01.06j effective 05/27/2026 with a code update adding five new CPT codes (0951T-0955T) to the Experimental/Investigational section for semi- and totally implantable middle ear hearing aids. Bone-anchored (osseointegrated) hearing aids remain covered for qualifying patients with conductive/mixed hearing loss or single-sided sensorineural deafness when medical necessity criteria are met. Implantable middle ear hearing devices remain non-covered experimental procedures.
Excellus BlueCross BlueShield policy 7.01.77 considers implantable bone conduction (bone-anchored) hearing aids medically appropriate as an alternative to an air-conduction hearing aid for members age five or older with conductive or mixed hearing loss, speech discrimination scores of at least 60% at elevated sound pressure levels, a bone-conduction pure-tone average up to 70 dB in the affected ear, and one of three listed ear conditions. They are also medically appropriate as an alternative to a CROS hearing aid for members age five or older with single-sided sensorineural deafness and normal hearing in the other ear, and all other uses, such as bilateral sensorineural hearing loss, are investigational. The current effective date is April 16, 2026, and the annual review left policy intent unchanged.
Independence Blue Cross has expanded cochlear implant coverage to include single-sided deafness (SSD) and asymmetric hearing loss (AHL) in patients age 5+, effective 09/08/2025. Simultaneously, restrictive replacement criteria were removed, and SSD/AHL were moved from experimental/investigational to medically necessary status. Billing teams must update systems to recognize new covered diagnoses and reference the DME repair/replacement policy for component coverage.
Independence Blue Cross has reissued MA11.049h to add five new CPT codes (0951T, 0952T, 0953T, 0954T, 0955T) to the Experimental/Investigational section effective 07/01/2025. These codes are now classified as not covered for bone-anchored and implantable middle ear hearing aids under Medicare Advantage plans. Billing teams must ensure these codes are not billed or are denied appropriately when submitted.
Independence Blue Cross reissued MA policy 11.049h (effective 05/28/2025) regarding bone-anchored osseointegrated hearing aids and implantable middle ear hearing aids. The policy confirms continued coverage for bone-anchored hearing aids meeting specific audiologic criteria for conductive/mixed hearing loss and single-sided sensorineural deafness, while implantable middle ear devices remain non-covered (experimental/investigational). External sound processors without osseointegration (L8692) are explicitly not covered.
Independence Blue Cross reissued policy 11.01.06j (effective 05/28/2025) to communicate its continuing position on bone-anchored (osseointegrated) hearing aids and implantable middle ear hearing aids. The policy maintains coverage for FDA-approved bone-anchored hearing aids as medically necessary alternatives to air-conduction hearing aids for conductive/mixed hearing loss and single-sided sensorineural deafness when specific audiologic criteria are met, while implantable middle ear hearing aids remain classified as experimental/investigational and not covered.
Aetna's Clinical Policy Bulletin 0013 sets medical necessity criteria for cochlear implants and auditory brainstem implants. Adults with bilateral sensorineural moderate-to-profound hearing impairment need a pure-tone average of 60 dB HL or greater at 500, 1000 and 2000 Hz, limited benefit from appropriately fitted hearing aids, and a hearing aid trial of at least 30 days worn full time, while children need a pure-tone average of 70 dB HL or greater at those frequencies and limited benefit from appropriately fitted binaural hearing aids. Cochlear implantation for auditory dyssynchrony, auditory neuropathy spectrum disorder, tinnitus and all other indications not meeting these criteria is considered experimental, investigational or unproven.
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.
Bilateral or unilateral cochlear implantation with an FDA-approved device may be considered medically necessary in individuals aged 7 months and older with bilateral severe-to-profound pre- or post-lingual sensorineural hearing loss (pure-tone average of 70 dB or greater at 500, 1000 and 2000 Hz) who have shown limited or no benefit from hearing aids. The age requirement was revised from 9 months to 7 months in the 08/03/2026 update. Cochlear implantation as a treatment for unilateral hearing loss with or without tinnitus is considered investigational.
Independence Blue Cross reissued MA11.049h effective 05/27/2026 with a code update adding five new CPT codes (0951T-0955T) to the Experimental/Investigational section for bone-anchored and implantable middle ear hearing aids. This is a minor administrative reissuance clarifying the Company's continuing coverage position; no changes to covered/non-covered services occurred.
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