Cochlear Implant

This policy covers cochlear implantation (including medically necessary replacement components and select hybrid cochlear implant/hearing‑aid systems) for patients with severe-to-profound sensorineural hearing loss — primarily children age ≥9 months with bilateral loss (pure‑tone average ≥70 dB), limited benefit from appropriately fitted hearing aids, and ability/willingness to participate in aural rehabilitation, with exceptions allowing earlier implantation for infants with cochlear ossification after bacterial meningitis or confirmed profound deafness. Coverage is limited to FDA‑approved devices and specified plan types (fully insured PPO/HMO/POS in Illinois effective 1/1/2025 and certain HCSC members per state law), requires a minimum 3‑month hearing‑aid trial for unilateral implants (and imaging/audiometric criteria as applicable), and excludes cosmetic/upgrade-only changes and unproven indications (e.g., treatment of unilateral hearing loss).

"Coverage of therapy services necessary to increase quality of life for children with a clinical or genetic diagnosis of a disease, syndrome, or disorder that includes low tone neuromuscular impairm..."