Oticon Alta

Medicare paying for Cochlear Implants?

Several factors support coverage and payment for bilateral cochlear implants under Medicare. Cochlear implants are covered under the statutory Medicare benefit provision for prosthetic devices. Medicare has a longstanding national coverage policy providing coverage for cochlear implants when the patient meets the coverage criteria. The national coverage policy and coverage limitations do not address or distinguish unilateral versus bilateral cochlear implantation. Certain Medicare reimbursement rules, however, are complex, are subject to change, and may vary from carrier to carrier.

According to its most recent National Coverage Determination, Medicare provides coverage for cochlear implantation for treatment of bilateral pre- or-post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of less than or equal to 40% correct in the best-aided listening condition on tape-recorded tests of open-set sentence cognition.

In the hospital outpatient setting, Ambulatory Payment Classification (APC) 0259 for cochlear implantation has a payment status indicator of T (Significant Procedure, Multiple Reduction Applies) that provides 100% of the APC payment rate for the first implant and 50% of the APC rate for the second implant. Again, Medicare coverage requirements must be met.


For more information on Advanced Bionics, visit www.bionicear.com

Share this article


1 person likes this

Comment

Related Content
Preferred Professionals Near You
See More Preferred Professionals

Clinics above not close enough?
Search with your zipcode below.

Sign Up for Our eNewsletter
Our free eNewsletter is delivered to your inbox every two weeks - it’s the best way to stay informed about what’s new at Healthy Hearing!
Preferred Hearing Professionals Near You

Total Hearing Care - Edison

4 Progress St Ste A1
Edison, NJ 08820

Click Here for Details

JFK Medical Center The Center for Audiology

65 James St
Edison, NJ 08820

Click Here for Details

ENT and Allergy Associates, LLP - Staten Island

1 Teleport Dr Ste 200
Staten Island, NY 10314

Click Here for Details