Congenital Cytomegalovirus (cCMV) infection is a leading cause of congenital SNHL. Its diagnosis is important in determining the prognosis for hearing retention and suggesting potential therapeutic options. In most of the United States cCMV screening is not mandated or routine. There are many testing paradigms that can be arranged and implementing these options can be daunting and technically difficult. In many communities, it is up to the individual otolaryngologist to advocate and arrange testing protocols. The purpose of this presentation is to discuss the challenges and opportunities for implementing a cCMV testing protocol in infants at risk for hearing loss in a non-mandated state. The speakers have developed such programs in both urban and rural community settings.