ICD-10 H90.6 is officially defined as "Mixed conductive and sensorineural hearing loss, bilateral." code H90.6 is referenced in 7 tracked payer policy changes from Independence Blue Cross, Excellus BlueCross BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H90.6 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.
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.
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.
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.
Independence Blue Cross reissued MA11.039e on 05/27/2026 with no substantive changes to cochlear implantation coverage criteria. The policy maintains existing coverage for bilateral moderate-to-profound sensorineural hearing loss meeting specific audiological and medical criteria, and continues to exclude unilateral hearing loss and assistive listening devices as experimental/investigational or non-covered. Billing teams should verify their system reflects the current policy version (05/27/2026) to ensure compliance.
Watch H90.6
Get one email when a payer policy names H90.6, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.