Cochlear Implantation

Medicare covers cochlear implantation for individuals with bilateral pre- or post-linguistic moderate-to-profound sensorineural hearing loss who demonstrate limited benefit from amplification (≤60% correct on best-aided open-set sentence recognition) and who meet additional criteria including cognitive ability for auditory use, no active middle ear infection, suitable cochlear anatomy, no auditory nerve/CNS lesions, no surgical contraindications, and use consistent with FDA labeling. Beneficiaries not meeting all criteria are not covered except when implanted within FDA-approved Category B IDE trials or as routine costs in qualifying clinical trials; the NCD effective date for these criteria is September 26, 2022.

"Bilateral pre- or post-linguistic sensorineural moderate-to-profound hearing loss in an individual who demonstrates limited benefit from amplification, defined as ≤60% correct in the best-aided lis..."