Cochlear Implant Replacements

Cochlear implant replacement, including external components and sound processors, is covered for patients with sensorineural hearing loss when the existing device is nonfunctional/unrepairable, when a change in the member’s condition makes the device inadequate for hearing-related activities of daily living, or when the component has reached its reasonable useful life (sound processor reasonable useful life not less than five years). Replacements are not indicated for functional or repairable devices, for convenience or technology upgrades, or prior to the minimum useful-life period; bilateral implantation in adults is not supported by sufficient evidence and carries increased surgical risk and cost, and state Medicaid provisions supersede this policy where applicable.

"Replacement of a cochlear implant or external component when the existing device is no longer functional and cannot be repaired."