Cochlear Implants - (0190)

Cigna covers traditional cochlear implants (initial, contralateral second, unilateral SSD/AHL, and medically necessary replacements) and FDA‑approved hybrid implants for adults who meet device‑specific candidacy, but implantation solely for tinnitus is not covered and hybrid implants are excluded for patients <18 years or with acoustic nerve/central lesions, active middle‑ear disease, absent cochlear development, or ≥30 years of severe‑to‑profound loss. Coverage requires meeting age‑ and device‑specific audiometric and speech‑recognition thresholds (e.g., adults bilateral PTA ≥70 dB with best‑aided open‑set sentence score ≤60%; adults unilateral CNC ≤5%; children profound thresholds ≥90 dB at 1 kHz and a 3‑month appropriately fitted binaural hearing‑aid trial unless waived for meningitis/cochlear ossification), plus preoperative audiologist/ENT evaluation, imaging as indicated, documentation of hearing‑aid trial or waiver, rehabilitation planning, and proof replacements are nonrepairable or impair ADLs without evidence of device abuse.