Cochlear Implants and Auditory Brainstem Implants

Aetna covers auditory brainstem implants for members ≥12 with bilateral loss (or planned bilateral removal) of the auditory nerves, cochlear implants (uni- or bilateral, including hybrid) for adults, children and infants who meet specified severity and functional criteria, and unilateral cochlear implantation for single-sided deafness/asymmetric loss in patients aged ≥1 year. Key requirements are age-specific cutoffs (ABI ≥12, standard adult CI ≥18, SSD/AHL ≥1), PTA severity thresholds (e.g., adults bilateral PTA ≥70 dB at 500/1000/2000 Hz; SSD defined as PTA ≥80 dB in the affected ear), documented limited benefit from appropriately fitted hearing aids with specified speech-test score cutoffs (e.g., ≤40% open‑set sentences for adults, ≤5% CNC for SSD adults, lower pediatric thresholds) and mandated hearing-aid trial durations (30 days/8 hr/day for adults, 3–6 months for hearing‑aid–naïve children, ≥1 month for SSD/AHL).

"Pre-implantation and post-implantation counseling with the patient and family regarding potential benefits, limitations, and prognosis (especially important in progressive neurologic conditions suc..."