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Cochlear Implants

Revised: May 17, 2023

Overview

A cochlear implant is a small electronic device that may help provide hearing to individuals who have moderate to profound hearing loss and would receive little or no benefits from hearing aids. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin.

Eligible Providers

· Hospitals

· Physicians

· Audiologists

Additional provider types may bill for specific parts and batteries identified in the table below. These include the following:

· Nurse practitioners

· Nurse midwives

· Physician assistants

· Hearing aid dispensers

· Medical suppliers

Eligible Members

Minnesota Health Care Programs (MHCP) will consider payment for uniaural (monaural) or binaural (bilateral) cochlear implantation, programming and related parts for MHCP members if they meet following criteria.

Criteria for adults

Adults 18 years and older must have all the following:

· Diagnosis of moderate to profound sensorineural hearing loss 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 cochlear implantation

Criteria for children

Children must be at least 1 year of age and have all the following:

· Diagnosis of bilateral severe to profound sensorineural hearing loss 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 U.S. Food & Drug Administration approved package insert

The child must be teachable and trainable so they are able to participate in the extensive post-operative rehabilitation.

Authorization

Certain cochlear implant devices require authorization as shown in the list below. To request an authorization, submit the Authorization Form (DHS-4695) (PDF) to the authorization medical review agent.

Required documentation

Authorization requests must include the following:

· Diagnosis with the appropriate ICD-10 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

Providers are responsible to coordinate services. Review MHCP Billing Policy for general billing requirements and guidance when submitting claims.

Bill cochlear implants using MN–ITS 837P. Refer to the MHCP MN–ITS 837P Professional User Guides for claim instructions.

Procedure Codes

Use the following table for billing codes and provider types that may provide and bill for the devices listed.

HCPCS Codes	Description	Authorization Required	Provider Types
L8614	Cochlear device, includes all internal and external components	Yes	Hospital, physician, audiologist
L8615	Headset/headpiece for use with cochlear implant device, replacement	No	Hospital, physician, audiologist, hearing aid dispenser, medical supplier
L8616	Microphone for use with cochlear implant device, replacement	No
L8617	Transmitting coil for use with cochlear implant device, replacement	No	Hospital, physician, audiologist, nurse practitioner, nurse midwife, physician assistant, hearing aid dispenser, medical supplier
L8618	Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement	No	Hospital, physician, audiologist, hearing aid dispenser, medical supplier
L8619	Cochlear implant, external speech processor and controller, integrated system, replacement	Yes
L8625	External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each	No
L8627	Cochlear implant, external speech processor, component, replacement	Yes
L8628	Cochlear implant, external controller component, replacement	Yes
L8629	Transmitting coil and cable, integrated, for use with cochlear implant device, replacement	Yes
L8690	Auditory osseointegrated device, includes all internal and external components	Yes	Hospital, physician, audiologist
L8691	Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each	Yes	Hospital, physician, audiologist, hearing aid dispenser, medical supplier
L8692	Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment	Yes
L8693	Auditory osseointegrated device abutement, any length, replacement only	No
L8694	Auditory osseointegrated device, transducer/actuator, replacement only	No
Replacement Batteries
L8621	Zinc air battery for use with cochlear implant devices, replacement	No	Hospital, physician, audiologist, nurse practitioner, nurse midwife, physician assistant, hearing aid dispenser, medical supplier
L8622	Alkaline battery for use with cochlear implant devices, any size, replacement, each	No
L8623	Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each	No	Hospital, physician, audiologist, hearing aid dispenser, medical supplier
L8624	Lithium ion battery for use with cochlear implement device or auditory osseointegrated device speech processor, ear level, replacement, each	No

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