H90.5 Insurance Policy Changes

ICD-10 H90.5 is officially defined as "Unspecified sensorineural hearing loss." code H90.5 is referenced in 5 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H90.5 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Jul 16, 2026Medium impact
Hyperbaric Oxygen Therapy (HBOT) 2.01.07
Excellus BlueCross BlueShield considers systemic hyperbaric oxygen therapy (HBOT) in a pressurized chamber medically appropriate for listed indications, including acute air or gas embolism, acute carbon monoxide poisoning, decompression sickness, idiopathic sudden sensorineural hearing loss, central retinal artery occlusion, and non-healing lower extremity wounds from diabetes that meet defined criteria. Topical HBOT is considered investigational, and systemic HBOT for all other listed indications, including acute ischemic stroke and migraine, is also considered investigational. The 07/16/26 annual review left the policy intent unchanged.
Aetna · Identified Oct 2, 2026Medium impact
Cochlear Implants and Auditory Brainstem Implants (CPB 0013, reviewed 2026-08-18)
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 · Identified Aug 15, 2026Medium impact
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.
Aetna · Identified Aug 14, 2026Medium impact
Electrocochleogram and Perilymphatic Pressure Measurement (CPB 0564, reviewed 2026-07-30)
Aetna covers electrocochleography (CPT 92584) when it is used to evaluate episodic dizziness (vertigo or imbalance) or tinnitus to rule out endolymphatic hydrops (Meniere's disease) and perilymphatic fistula, or when it is performed with auditory brainstem response testing for profound hearing loss, defined as a pure tone average of 90 dB HL or greater at 500, 1,000, 2,000 and 4,000 Hz. Electrocochleography is experimental, investigational or unproven for routine hearing screening, for improving pre-implantation counseling for cochlear implant recipients, for intra-operative evaluation of cochlear trauma during cochlear implantation, and for superior semicircular canal dehiscence repair and canal resurfacing. Measurement of perilymphatic pressure is experimental, investigational or unproven for managing Meniere's disease or idiopathic sudden sensorineural hearing loss.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Cochlear Implants
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H90.5?

There are 5 tracked policy changes affecting code H90.5, including updates from Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H90.5?

Payers that have issued tracked updates for code H90.5 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code H90.5 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H90.5. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code H90.5?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Hyperbaric Oxygen Therapy (HBOT) 2.01.07

Cochlear Implants and Auditory Brainstem Implants (CPB 0013, reviewed 2026-08-18)

Cochlear Implants and Auditory Brainstem Implants (CPB 0013, reviewed 2026-03-05)

Electrocochleogram and Perilymphatic Pressure Measurement (CPB 0564, reviewed 2026-07-30)

Cochlear Implants

What insurance policy changes affect code H90.5?

Which payers have updated policy for code H90.5?

How do I get notified when code H90.5 policy changes?

Why do payers change policies for code H90.5?