L8615, Headset/headpiece for use with cochlear implant device, replacement
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without 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.
- Replacement of a cochlear implant or external component when the existing device is no longer functional and cannot be repaired.
- Replacement when a change in the member's condition makes the existing unit inadequate for hearing-related activities of daily living and improvement is expected with a replacement.
- Replacement when the existing component has reached the limit of its reasonable useful life (reasonable useful life of a sound processor is not less than five years).
7 Active Policies
A53708, Billing and Coding: External Components for Cochlear Implants
UHC-POL-cochlear-implants, Cochlear Implants
AMBETTER-CP.MP.14, Cochlear Implant Replacements
AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines
REGENCE-SUR08, Cochlear Implant
Related Codes
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