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Cochlear Implants Revised: 03-05-2015 A cochlear implant is a prosthetic device that may help provide hearing to those who have profound deafness and would receive little or no benefits from hearing aids. Criteria for cochlear implantation and programming MHCP will consider payment for cochlear implantation and programming when the following criteria are met: Authorization All cochlear implant purchases and replacement devices require authorization. Criteria for Adults Adults age 18 and older must have all of the following: Diagnosis of moderate to profound sensorineural deafness that cannot be mitigated by use of a hearing aid in patients whose auditory cranial nerves are stimulable Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation Freedom from chronic 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 Criteria for Children Children must be at least 12 months of age and must have all of the following: Diagnosis of bilateral severe to profound sensorineural deafness with little or no benefit from a hearing (or vibrotactile) aid in patients whose auditory nerves are stimulable Freedom from middle ear infection and accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic area of the central nervous system No contraindication to the implant, including those described in the product’s FDA approved package insert The child must be teachable and trainable so he or she is able to participate in the extensive post-operative rehabilitation . Required documentation Claims must include the following: Diagnosis with the appropriate ICD code Medical history pertaining to the cochlear implant Reports Audiology: including the final report from any pre-cochlear implant hearing training (children) Speech: including test results of age-appropriate closed-set work identification tasks and other tests Psychology: including a clear statement as to the individual’s cognitive ability to participate in the post-surgical rehabilitation program Billing Refer to the following table for billing codes and provider types that may provide and bill for the services listed. HCPCS Description Provider Type Codes Cochlear Implant Service L8614 Cochlear device, includes all internal and external components Hospital, physician Replacement cochlear components L8615 Headset/headpiece for use with cochlear implant device, replacement Hospital, physician, audiologist, hearing L8616 Microphone for use with cochlear implant device, replacement instrument dispenser, L8617 Transmitting coil for use with cochlear implant device, medical supplier replacement L8618 Transmitter cable for use with cochlear implant device, replacement L8619 Cochlear implant, external speech processor and controller, integrated system, replacement L8627 Cochlear implant, external speech processor, component, replacement L8628 Cochlear implant, external controller component, replacement L8629 Transmitting coil and cable, integrated, for use with cochlear implant device, replacement Batteries L8621 L8622 L8623 L8624 Zinc air battery for use with cochlear implant devices, replacement Alkaline battery for use with cochlear implant devices, any size, replacement, each Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each Lithium ion battery for use with cochlear implement device speech processor, ear level, replacement, each