Regence BlueShieldAll Plans · Coverage · Medical Policy · ENT (Ear, Nose & Throat), Audiology, PediatricsMedium impact
Cochlear Implants
Effective date
Oct 1, 2026
Identified
Oct 7, 2026
Summary
Medical Policy SUR08 (Cochlear Implant) is effective October 1, 2026. Cochlear implants may be considered medically necessary for bilateral severe to profound pre- or postlingual sensorineural hearing loss, defined as a pure-tone average of 70 dB or greater at 500, 1000 and 2000 Hz, when the individual has limited or no benefit from appropriately fitted hearing aids and the implanted device is FDA approved for the indication and age of the individual. Hybrid cochlear implant/hearing aid systems, cochlear implants for single-sided deafness and asymmetric hearing loss in individuals five years of age or older, and implant replacement may also be considered medically necessary when their criteria are met. Cochlear implantation in individuals younger than 7 months of age is considered not medically necessary.
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01Already effective 2026-10-01: Clinical documentation supporting the criteria is required, including history and physical or chart notes, the manufacturer and model name of the cochlear implant being requested, and audiology test results.
02If any of these items are not submitted, it could impact the review and decision outcome.
03Confirm that the implanted device is FDA approved (PMA or 510(k) only) for the indication and age of the individual, document limited or no benefit from appropriately fitted hearing aids, and confirm that none of the listed contraindications apply, including inability or lack of willingness to participate in post-implantation aural rehabilitation.
04Repeat hearing tests or hearing aid trials are not necessary for patients who have previously met Criteria I and II.
05Implantation is considered not medically necessary when one of the criteria is not met, and replacement of an implant is considered not medically necessary when its criteria are not met.
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