Cochlear Implants and Auditory Brainstem Implants — CPB 0013 | AETNA Coverage Update

Aetna modified CPB 0013 for cochlear implants and auditory brainstem implants, effective March 7, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated Clinical Policy Bulletin CPB 0013 covering cochlear implantation (CPT 69930) and auditory brainstem implants (HCPCS S2235). The revision refines medical necessity thresholds across adult, pediatric, and single-sided deafness populations. It also updates coverage for related services billed under CPT codes 92601–92604, 92626–92633, and the full L8614–L8629 HCPCS device code range. If your practice bills for cochlear implant services under Aetna plans, audit your authorization workflows and documentation standards against this update before March 7, 2026.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Cochlear Implants and Auditory Brainstem Implants
Policy Code	CPB 0013
Change Type	Modified
Effective Date	March 7, 2026
Impact Level	High
Specialties Affected	Audiology, ENT/Otolaryngology, Neurosurgery, Pediatrics, Speech-Language Pathology, DME suppliers
Key Action	Verify that documentation for CPT 69930 and S2235 meets updated medical necessity thresholds before submitting claims after March 7, 2026

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Aetna Cochlear Implant Coverage Criteria and Medical Necessity Requirements 2026

The Aetna cochlear implant coverage policy under CPB 0013 sets distinct medical necessity criteria for three patient populations: adults, children, and individuals with single-sided deafness (SSD) or asymmetric hearing loss (AHL). Getting the criteria wrong for the population you're treating is the fastest path to a claim denial.

Adults (Age 18 and Older)

For adults, Aetna covers uniaural or binaural cochlear implantation (CPT 69930, HCPCS L8614) when all of the following are met:

#	Covered Indication Copy
1	Pure-tone average (PTA) of ≥60 dB HL at 500 Hz, 1000 Hz, and 2000 Hz
2	Limited benefit from appropriately fitted hearing aids — defined as a monosyllabic word recognition score of ≤50% correct on the Consonant-Nucleus-Consonant (CNC) test in the ear to be implanted, or ≤60% correct on open-set sentence testing (AzBio, HINT) in the best-aided condition
3	Cognitive ability to use auditory clues and willingness to participate in post-implant rehabilitation

Adults with bilateral hearing loss must also complete a minimum 30-day hearing aid trial with aids worn full time — at least 8 hours per day. Missing this documentation is a predictable claim denial trigger. Make sure your pre-authorization packet includes dated hearing aid dispensing records and a signed trial attestation.

Children (Infants and Pediatric Patients)

Aetna's coverage policy for pediatric cochlear implant patients requires a more stringent audiometric threshold. Children must show a bilateral sensorineural hearing loss with an air conduction PTA of ≥70 dB HL at 500 Hz, 1000 Hz, and 2000 Hz — 10 dB higher than the adult threshold.

Children must also complete a 3-to-6 month hearing aid trial before implantation, unless radiology confirms cochlear ossification. In that case, Aetna may waive the trial at its discretion. Document that radiological evidence explicitly in the prior authorization request — don't assume Aetna's reviewers will connect the dots.

Limited benefit in children is measured differently than in adults. Aetna accepts multiple tools: the AzBio Sentence Test, Bamford-Kowal-Bench (BKB-SIN), CNC, Early Speech Perception (ESP), HINT-C, IT-MAIS, MAIS, MLNT/LNT, Pediatric Minimum Speech Test Battery, and Phonetically Balanced Kindergarten Test. Use whichever tool fits the child's developmental level, but document the specific test, the score, and the age-normative comparison in the record.

Single-Sided Deafness and Asymmetric Hearing Loss (Age 1 and Older)

Aetna covers uniaural cochlear implantation for SSD and AHL patients age one and older. This is a distinct pathway from the bilateral sensorineural population. The criteria for this group are referenced in the policy but were truncated in the available summary — if you treat SSD patients, pull the full CPB 0013 document directly and verify the specific audiometric and trial requirements before submitting a prior auth request.

Auditory Brainstem Implants

The auditory brainstem implant (ABI) covered under HCPCS S2235 and CPT 92640 carries a narrower indication. Aetna covers ABI for members 12 years and older who have lost both auditory nerves due to disease — typically neurofibromatosis or von Recklinghausen's disease — or for those undergoing planned bilateral surgical removal of auditory nerve tumors expected to result in complete bilateral deafness.

The age floor of 12 is firm. Requests for younger patients will not meet medical necessity under this policy.

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Aetna Cochlear Implant Exclusions and Non-Covered Indications

Aetna does not cover several auditory evoked potential codes under CPB 0013. These are explicitly listed as not covered for indications in the CPB:

Billing these codes in conjunction with cochlear implant services will generate a denial. If your team is bundling these into pre-implant workup claims, remove them. The clinical utility may be real, but Aetna does not consider them covered for these indications.

HCPCS G0176 — activity therapy (music, dance, art, or play therapies for recreational use) — is also excluded. This sometimes comes up in pediatric post-implant rehabilitation programs. Don't bill it expecting coverage under this policy.

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Coverage Indications at a Glance

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Aetna Cochlear Implant Billing Guidelines and Action Items 2026

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Cochlear Implants and Auditory Brainstem Implants Under CPB 0013

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered CPT Codes

Other CPT Codes Related to CPB 0013

Covered HCPCS Codes (When Selection Criteria Are Met)

Not Covered HCPCS Codes

Code	Description	Reason Copy
G0176	Activity therapy (music, dance, art, or play therapies not for recreation, related to care)	Not covered for indications listed in CPB 0013

Other HCPCS Codes Related to CPB 0013

Code	Description Copy
G0009	Administration of pneumococcal vaccine
L8699	Prosthetic implant, not otherwise specified (auditory brainstem implant)
V5273	Assistive listening device, for use with cochlear implant

Key ICD-10-CM Diagnosis Codes

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