CSHCN 2009 > Hearing Services > Benefits, Limitations, and Authorization Requirements

19.2.5 Cochlear Implants

Cochlear implants and aural rehabilitation are benefits for CSHCN Services Program clients who meet the following criteria:

•The client is 12 months of age or older.

•The client has a profound, bilateral, sensorineural hearing loss.

•The client who requests the cochlear implant has had limited or no benefit from a trial with appropriately fitted hearing aids. A trial of 3 to 6 months is required for clients who do not have previous experience with hearing aids unless there is a documented reason that hearing aids will not work for that particular client.

•The client has the cognitive ability to use auditory cues.

•The client or parents are willing and able to comply with aural rehabilitation.

•The client is assessed by both an audiologist and an otolaryngologist experienced in the implantation of cochlear implants or auditory brainstem implants (ABIs) and who indicate that the client is a good candidate for the procedure.

Cochlear implants are not considered for reimbursement when one or more of the following situations exist:

•The client has an active ear infection.

•The client is deaf due to lesions of the acoustic nerve or central auditory pathways.

•There is radiological documentation of absent cochlear development.

•The client or the client's parents lack the cognitive ability or willingness to complete aural rehabilitation.

Procedure code 69930 (reimbursed to physicians, APNs, and hospitals) must be used for the cochlear implant device, implantation and components. The device and separate components include the cochlear device itself, headpiece/headset, microphone, transmitting coil, transmitter cable, external speech processor, zinc air batteries, alkaline AA batteries, recharger units, and rechargeable AA batteries.

Note: The device must be approved by the FDA and must be age-appropriate for the client.

Up to a maximum of 15 zinc air or a maximum of 31 alkaline replacement batteries per month are benefits.

ABI is an adaptation of a cochlear implant. It is a benefit of the CSHCN Services Program for clients 12 years of age or older when submitted with the following:

A diagnostic analysis of a cochlear implant and its subsequent programming are considered for reimbursement to physicians, APNs, audiologists, hospitals, and rehabilitation centers using procedure codes 92601, 92602, 92603, and 92604.

Replacement components and nonrechargeable batteries must be submitted for reimbursement using the following procedure codes:

Refer to: Section 17.3.4, "Cochlear Implant Device".

Section 19.2.5, "Cochlear Implants".

Section 29.2.13, "Cochlear Implants".