CommercialCoverageMedium impact
Cochlear Implants and Auditory Brainstem Implants 7.01.26
Excellus BlueCross BlueShield·ENT (Ear, Nose & Throat)·Ear, Nose & Throat (Otorhinolaryngology)
Effective date
Mar 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their cochlear implant and auditory brainstem implant policy effective March 19, 2026, establishing specific medical necessity criteria for unilateral/bilateral cochlear implants, single-sided deafness, hybrid implants, and auditory brainstem implants. The policy includes detailed hearing loss thresholds, contraindications, and requirements for device repair and replacement coverage.
Action Required
By March 19, 2026: ENT providers and billing team must review and implement new medical necessity criteria for cochlear implant authorizations. Ensure documentation includes FDA approval verification, specific hearing loss measurements (PTA >70 dB HL for bilateral SNHL, >90 dB HL for single-sided deafness), evidence of limited hearing aid benefit, physician attestation of rehabilitation willingness, and absence of contraindications. Update prior authorization checklists and EMR templates to capture required audiometric data and clinical criteria.