L8614, Cochlear device, includes all internal and external components
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Documentation Required
- Physician certification is required for coverage documenting that the component is ineffective for ADLs, that a medical-condition change necessitates a different component, or that the component reached reasonable useful life.
- For repairs, include original purchase date of the item repaired, the reason for repair/replacement, identification of the item and parts repaired, functionality status, and the manufacturer invoice cost.
- When billing replacements include original purchase date, last replacement date of the item billed, and reason for replacement.
- For exceptions to battery or other limits, submit a narrative in item #19 of the electronic 5010 claim form or an attachment for paper claims.
Key Coverage Criteria
- Replacement of an existing cochlear implant external component is covered when a physician certifies the existing component is ineffective to the point of interfering with activities of daily living.
- Replacement is covered when a change in the patient's medical condition necessitates a different type of external cochlear implant component as certified by a physician.
- Replacement is covered when the existing external component has reached its reasonable useful life; the reasonable useful life of a sound processor is not less than 5 years.
- CPT codes covered if criteria are met: 92640 Diagnostic analysis with programming of auditory brainstem implant, per hour
- HCPCS codes covered if selection criteria are met: S2235 Implantation of auditory brain stem implant
- Persons with a unilateral cochlear implant may qualify for subsequent bilateral implantation without retesting if medical records document they met criteria at time of initial implantation.
12 Active Policies
ANTHEM-CG-SURG-81, CG-SURG-81 Cochlear Implants and Auditory Brainstem Implants
A53708, Billing and Coding: External Components for Cochlear Implants
UHC-POL-cochlear-implants, Cochlear Implants
AETNA-CPB-0013, Cochlear Implants and Auditory Brainstem Implants
AETNA-CPB-0514, Meniere's Disease and Related Disorders: Surgery
Related Codes
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