CG-SURG-81 Cochlear Implants and Auditory Brainstem Implants

This policy addresses coverage for cochlear implants and auditory brainstem implants. Cochlear implantation is medically necessary for unilateral or bilateral sensorineural deafness when the ear(s) to be implanted have ≥70 dB loss and the individual has limited benefit from conventional hearing aids, can participate in post-implant rehabilitation (parent/guardian may act as surrogate for young children), and has no active middle ear infection, lesions of the auditory nerve or central auditory pathway, or auditory neuropathy spectrum disorder; implantation may be unilateral, bilateral-simultaneous, or bilateral-sequential (no repeat hearing tests needed between sequential procedures). Not medically necessary: cochlear implants for indications not meeting these criteria (including tinnitus without severe hearing loss), upgrades/replacements of external processors/controllers or remote assistants when criteria are not met, and auditory brainstem implants for indications not meeting policy criteria.