Who is affected by this change?

This affects Excellus BlueCross BlueShield ENT (Ear, Nose & Throat), Audiology providers in NY on Commercial, Medicare Advantage, Medicaid plans.

When does this change take effect?

This change is effective Mar 19, 2026.

What do I need to do?

Already effective March 19, 2026: Claims for cochlear implants for bilateral hearing loss need documentation that the listed criteria are met, including a pure-tone average above 70 dB HL at 500, 1000 and 2000 Hz, limited or no benefit from appropriately fit hearing aids, FDA approval for the individual's age, and physician attestation that the individual or family is willing to undergo an extended program of auditory rehabilitation. Claims for single-sided deafness or asymmetric hearing loss need documentation of age five or older, a one-month CROS hearing aid trial with no benefit, and the same physician attestation. Claims for device repair need physician documentation of the implantation or initiation date, manufacturer warranty information if applicable, and an attestation that the individual has been compliant with device use and will continue to benefit. Claims for replacement of a properly functioning device are considered not medically necessary. Repair or replacement of equipment damaged or lost due to the individual's neglect, theft or abuse, or where another coverage source is an option, is ineligible for coverage. Check current applicability before relying on these requirements.

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Excellus BlueCross BlueShieldCommercial · Administrative · Ear, Nose & Throat (Otorhinolaryngology) · NY · ENT (Ear, Nose & Throat), AudiologyMedium impact

Cochlear Implants and Auditory Brainstem Implants 7.01.26

Q: Which billing codes are affected?

The following codes are affected: 69930, 92601, 92602, 92603, 92604, 92605, 92618, 92640, L8614, L8615, L8619, L8621, L8624, L8625, L8627, L8628, L8629, S2235, H90.3, H90.8, H90.A2, H90.A32, H91.3, H93.3X1, H93.3X9, Q85.02, Z96.21.

Effective date

Mar 19, 2026

Identified

Jun 20, 2026

Summary

Excellus BlueCross BlueShield medical policy 7.01.26 covers cochlear implants and auditory brainstem implants and states when each is considered medically appropriate. Unilateral and bilateral cochlear implants are considered appropriate for bilateral severe-to-profound sensorineural hearing loss when all listed criteria are met, including a pure-tone average above 70 dB HL at 500, 1000 and 2000 Hz and limited or no benefit from appropriately fit hearing aids. The policy also covers unilateral implants for single-sided deafness or asymmetric hearing loss, hybrid cochlear implants, auditory brainstem implants for neurofibromatosis type 2, and repair and replacement of devices. The current effective date is March 19, 2026, and the April 22, 2026 edit added reference resources.

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What to do

Action · 6 steps

01Already effective March 19, 2026: Claims for cochlear implants for bilateral hearing loss need documentation that the listed criteria are met, including a pure-tone average above 70 dB HL at 500, 1000 and 2000 Hz, limited or no benefit from appropriately fit hearing aids, FDA approval for the individual's age, and physician attestation that the individual or family is willing to undergo an extended program of auditory rehabilitation.

02Claims for single-sided deafness or asymmetric hearing loss need documentation of age five or older, a one-month CROS hearing aid trial with no benefit, and the same physician attestation.

03Claims for device repair need physician documentation of the implantation or initiation date, manufacturer warranty information if applicable, and an attestation that the individual has been compliant with device use and will continue to benefit.

04Claims for replacement of a properly functioning device are considered not medically necessary.

05Repair or replacement of equipment damaged or lost due to the individual's neglect, theft or abuse, or where another coverage source is an option, is ineligible for coverage.

06Check current applicability before relying on these requirements.

Codes mentioned

6993092601926029260392604926059261892640L8614L8615L8619L8621L8624L8625L8627L8628L8629S2235H90.3H90.8H90.A2H90.A32H91.3H93.3X1H93.3X9Q85.02Z96.21

Original notice

Cochlear Implants and Auditory Brainstem Implants 7.01.26

excellusbcbs.com · Always check the source before changing claims.

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Hyperbaric Oxygen Therapy (HBOT) 2.01.07MediumEffective Jul 16, 2026 · Miscellaneous Augmentative and Alternative Communication Systems (e.g., Speech-generating Devices) 1.01.03MediumEffective Aug 20, 2026 · Durable Medical Equipment & Supplies Implantable Bone Conduction Hearing Aids 7.01.77MediumEffective Apr 16, 2026 · Ear, Nose & Throat (Otorhinolaryngology)Browse every Excellus BlueCross BlueShield change in the policy list

Cochlear Implants and Auditory Brainstem Implants 7.01.26

Summary

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What to do

Codes mentioned

Original notice

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