US · guidance
CMS Pub. 100-04, ch. 32, § 100
Billing Requirements for Expanded Coverage of Cochlear Implantation
Effective for dates of services on and after September 26, 2022, the Centers for Medicare & Medicaid
Services (CMS) has expanded the coverage for cochlear implantation to cover bilateral pre- or post- linguistic,
sensorineural, moderate-to-profound hearing loss in individuals with hearing test scores equal to or less than
60% correct in the best aided listening condition on recorded tests of open-set sentence recognition and who
demonstrate limited benefit from amplification. (See Publication 100-03, Chapter 1, Section 50.3, for
complete coverage criteria).
In addition, CMS is covering cochlear implants for beneficiaries not meeting the coverage criteria listed
under Publication 100-03, Chapter 1, Section 50.3 when performed in context with:
• A Food and Drug Administration (FDA)-approved category B investigational device exemption (IDE)
clinical trial as defined at 42 CFR 405.201; or
• As a routine cost in a clinical trial under the CMS clinical trial policy (see Pub. 100-03, section 310.1).
History
(Rev. 11875; Issued:02-23-23; Effective: 09-26-22; Implementation: 03-24-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
37200bde5a9a453ab230ba2890cfab4d11729117e6fec2290fd1aa481efdef73
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