Cochlear Implants – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers cochlear implantation when medically necessary per InterQual criteria — non‑hybrid implants for adults (≥18) with bilateral or single‑sided/asymmetric sensorineural hearing loss and for children ≥6 months (bilateral) or ≥9 months (single‑sided/asymmetric), hybrid implants for adults ≥18; non‑hybrid implantation in younger infants and FM systems are excluded, external components are DME, and remapping/rehab are billed as outpatient therapy subject to plan limits. Coverage requires documentation that the member meets the applicable InterQual CP (adult or pediatric), including prior treatments tried/failed with dates/duration/reasons and recent imaging/diagnostic tests, and is subject to the member‑specific benefit plan.

"Non-hybrid cochlear implantation is proven and medically necessary under certain circumstances for bilateral sensorineural and/or for single sided or asymmetric Sensorineural Hearing Loss in adults..."