S2235 — Implantation of auditory brain stem implant
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Documentation of diagnosis of neurofibromatosis type 2 (NF2).
- Documentation of patient age (≥12 years).
- Surgical documentation if implant placed at time of tumor removal (first-side or second-side) as relevant to approval basis.
- Clinical or operative documentation confirming deafness following tumor removal.
Key Coverage Criteria
- Cochlear implantation is considered medically necessary whenbothcriterion 1andcriterion 2 listed below are met:The individual meetsAllthe following criteria (a through c):Has received limited benefit from conventional hearing aids;andIs able to participate* in a post-cochlear implant rehabilitation program;andAbsence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorde [...]
- The individual meetsAllthe following criteria (a through c):Has received limited benefit from conventional hearing aids;andIs able to participate* in a post-cochlear implant rehabilitation program;andAbsence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorders.*Note: For a young child, a parent or guardian may act as the surrogate for participation.and
- Has received limited benefit from conventional hearing aids;and
- Is able to participate* in a post-cochlear implant rehabilitation program;and
- Absence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorders.*Note: For a young child, a parent or guardian may act as the surrogate for participation.and
- Active middle ear infections;or
6 Active Policies
ANTHEM-CG-SURG-81 — CG-SURG-81 Cochlear Implants and Auditory Brainstem Implants
BCBSIL-SUR714.009 — Auditory Brainstem Implant
BCBSMT-SUR714.009 — Auditory Brainstem Implant
BCBSNM-SUR714.009 — Auditory Brainstem Implant
BCBSOK-SUR714.009 — Auditory Brainstem Implant
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.