L8625, External recharging system for battery for use with cochlear implant or
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- History and Physical/Chart Notes must be submitted.
- Manufacturer and model name of the cochlear implant being requested must be provided.
- Audiology test results must be submitted.
Key Coverage Criteria
- Contralateral ear mild to moderately severe SNHL with ≥ 15 dB PTA difference between ears (asymmetric hearing loss).
- Documented limited benefit from an appropriately fitted unilateral hearing aid in the ear to be implanted is required.
- Implanted device must be FDA approved (PMA or 510(k)) for unilateral single-sided deafness cases.
- Age 12 months or older.
- No deafness due to lesions of the acoustic nerve, central auditory pathways, or brain stem in the implanted ear.
- Age 9 months or older for the Nucleus 24 cochlear implant system (with any of the Cochlear® sound processors).
2 Active Policies
REGENCE-SUR08, Cochlear Implant
REGENCE-SUR121, Transcutaneous Bone-Conduction and Bone-Anchored Hearing Aids
Related Codes
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