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36.4.8 Cochlear Implants
Cochlear implants, when medically indicated, are benefits of the Texas Medicaid Program. A cochlear implant device (procedure code 2/F-69930) is an electronic instrument, part of which is implanted surgically to stimulate auditory nerve fibers, and part of which is worn externally to capture and amplify sound. These devices are available in single and multi-channel models. Cochlear implants are used to provide awareness and identification of sound and to facilitate communication for persons who are profoundly hearing impaired.
The device must be FDA-approved and the approved device must be age-appropriate for the client. The device and separate components include the cochlear device itself, headpiece/headset, microphone, transmitting coil, transmitter cable, external speech processor, zinc air batteries, AA alkaline batteries, recharger units, and rechargeable AA batteries. A total of 12 replacement rechargeable batteries are a benefit per year. Up to a maximum of 15 Zinc Air batteries or a maximum of 31 alkaline batteries per month are benefits.
Reimbursement is provided only for those patients who meet all of the following criteria:
• Diagnosis of total bilateral sensorineural deafness that cannot be mitigated by use of a hearing aid in clients whose auditory cranial nerve is stimulable.
•Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation.
•Post-lingual deafness or pre-lingual deafness.
•Twelve months of age or older.
•Freedom from 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.
The payment for the cochlear implant is limited to the following diagnosis codes:
Tuning and adjustment of the external device is included in the package of services.
Diagnostic analysis of the cochlear implant in the event of a malfunction may be considered for reimbursement using procedure codes 1-92601, 1-92602, 1-92603, 1-92604.
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