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Cochlear Implants: Bilateral versus Unilateral

Coverage decision: Covered with conditions

Conditions of Coverage

  • Bilateral Cochlear Implants are covered for patients who are ≥ 12 months or older;
  • Bilateral severe to profound sensorineural hearing loss;
  • Limited or no benefit from hearing aids;
  • Cognitive ability and willingness to participate in an extensive auditory rehabilitation program;
  • Freedom from 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 other contraindications for surgery; and
  • Device used in accordance with the FDA approved labeling.
 
Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed cochlear implants: bilateral versus unilateral on May 17, 2013. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that bilateral cochlear implants are covered benefits with conditions.  Complete information on this HTCC determination is available here: www.hca.wa.gov/hta/Pages/Forms/HTA_Findings.aspx.

 
Implementation of the Determination

Bilateral cochlear implants may be used only for care of a condition accepted on the claim.  All requests require prior authorization.

 
For State Fund Claims

Please contact Utilization Review Vendor (Qualis): www.Lni.wa.gov/ClaimsIns/Providers/AuthRef/UtilReview/.

 
For Self-Insured Claims

Please contact the self-insured employer (SIE) or their third party administrator (TPA). For a list of SIE/TPAs, go to: www.Lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/Default.asp.

 
Billing Codes

CPT Codes: 69930, 92603, and 92604
HCPCS Codes:
L8614 (Payment is bundled in the facility payment for the surgical procedure),
L8621 - L8624 (Requires prior authorization by Provider Hotline), and
L8615 - L8619 and L8627 - L8629 (Requires prior authorization by Claim Manager).

 

Health Care Authority's Health Technology Assessment Program site

For more information:
Contact information.

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