1. Contact the customer service department (information is on the back of your health insurance card).
2. Ask, “Is procedure code 69930 covered under my policy?”
3. Your insurance provider may request the following information.
   1. Diagnosis code. It is H90.3 (sensorineural hearing loss, bilateral).
   2. Device code. It is L8614.
   3. Cochlear implant surgery is an outpatient procedure.

The insurance company will not be able to provide an exact cost until your doctors submit a claim. However, your insurer should give you information about the portion of the cost for which you will be responsible. This cost may include services and fees not covered by insurance, as well as a copay or a deductible that applies at the time of surgery. For example, your insurance provider may cover 80% of the cost, which means you will be responsible for the remaining 20% of the cost.

Your doctors’ appointments before and after the implant surgery may be billed separately. For instance, the cost of the internal and external device may be included in the cost of surgery, but cochlear implant activation may not be covered in the cost of the surgery.

Medicare covers cochlear implants for some people, and eligibility for older adults was expanded by the Centers for Medicare & Medicaid Services in September 2022. This change allows Medicare beneficiaries with aided speech discrimination test scores of up to 60% to consider cochlear implantation if hearing aids are no longer helpful. (Previous guidelines only provided coverage for patients who scored less than 40% on aided speech discrimination tests, leaving many unable to obtain cochlear implants even though their hearing was impaired.)

The decision provides a significant improvement in access to care for those with moderate to profound sensorineural hearing loss.