Summary
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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What to do
Action · 5 steps
01Billing team: For bilateral or unilateral implantation, confirm the documentation shows the criteria above, including age 7 months or older, the hearing thresholds, and limited or no benefit from hearing aids, before billing CPT 69930 and the device codes.
02Billing team: Bill bilateral implantation only when the documentation shows that unilateral implantation plus a hearing aid in the other ear will not result in a binaural benefit.
03Billing team: Implantation for unilateral hearing loss, cosmetic upgrades, and replacement for upgrade to a newer system are considered investigational.
04Replacement of components is considered medically necessary only when the existing component gives an inadequate response that interferes with daily living, or the component is no longer functional and cannot be repaired.
05Billing team: For hybrid implants with a hearing aid in the sound processor, such as the Nucleus Hybrid L24, check the criteria for individuals 18 years and older before billing.
Codes mentioned
6993069949925079250892601926029260392604L8614L8615L8616L8617L8618L8619L8623L8624L8625L8627L8628L8629H90.3H90.41H90.42H90.5H90.A21H90.A22H91.3
Original notice
Cochlear Implants
bcbsms.com · Always check the source before changing claims.
Related changes
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Blue Cross & Blue Shield of Mississippi policiesENT (Ear, Nose & Throat)AudiologyCode 69930Code 69949Code 92507Code 92508Code 92601Code 92602Code 92603Code 92604Code L8614Code L8615Code L8616Code L8617Code L8618Code L8619Code L8623Code L8624Code L8625Code L8627Code L8628Code L8629Code H90.3Code H90.41Code H90.42Code H90.5Code H90.A21Code H90.A22Code H91.3