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Cochlear Implants

Revised: 03-05-2015

A cochlear implant is a prosthetic device that may help provide hearing to those who have profound deafness and would receive little or no benefits from hearing aids.

Criteria for cochlear implantation and programming

MHCP will consider payment for cochlear implantation and programming when the following criteria are met:

Authorization

All cochlear implant purchases and replacement devices require authorization.

Criteria for Adults

Adults age 18 and older must have all of the following:

  • • Diagnosis of moderate to profound sensorineural deafness that cannot be mitigated by use of a hearing aid in patients whose auditory cranial nerves are stimulable
  • • Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation
  • • Freedom from chronic middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system
  • • No contraindications to surgery
  • Criteria for Children

    Children must be at least 12 months of age and must have all of the following:

  • • Diagnosis of bilateral severe to profound sensorineural deafness with little or no benefit from a hearing (or vibrotactile) aid in patients whose auditory nerves are stimulable
  • • Freedom from middle ear infection and accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic area of the central nervous system
  • • No contraindication to the implant, including those described in the product’s FDA approved package insert
  • The child must be teachable and trainable so he or she is able to participate in the extensive post-operative rehabilitation .

    Required documentation

    Claims must include the following:

  • Diagnosis with the appropriate ICD code
  • Medical history pertaining to the cochlear implant
  • Reports
  • Audiology: including the final report from any pre-cochlear implant hearing training (children)
  • Speech: including test results of age-appropriate closed-set work identification tasks and other tests
  • Psychology: including a clear statement as to the individual’s cognitive ability to participate in the post-surgical rehabilitation program
  • Billing

    Refer to the following table for billing codes and provider types that may provide and bill for the services listed.

    HCPCS Codes

    Description

    Provider Type

    Cochlear Implant Service

    L8614

    Cochlear device, includes all internal and external components

    Hospital, physician

    Replacement cochlear components

    L8615

    Headset/headpiece for use with cochlear implant device, replacement

    Hospital, physician, audiologist, hearing instrument dispenser, medical supplier

    L8616

    Microphone for use with cochlear implant device, replacement

    L8617

    Transmitting coil for use with cochlear implant device,

    replacement

    L8618

    Transmitter cable for use with cochlear implant device, replacement

    L8619

    Cochlear implant, external speech processor and controller, integrated system, replacement

    L8627

    Cochlear implant, external speech processor, component, replacement

    L8628

    Cochlear implant, external controller component, replacement

    L8629

    Transmitting coil and cable, integrated, for use with cochlear implant device, replacement

    Batteries

    L8621

    Zinc air battery for use with cochlear implant devices, replacement

    L8622

    Alkaline battery for use with cochlear implant devices, any size, replacement, each

    L8623

    Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each

    L8624

    Lithium ion battery for use with cochlear implement device speech processor, ear level, replacement, each

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