Billing Requirements for Expanded Coverage of Cochlear Implantation
Effective for dates of services on and after April 4, 2005, the Centers for Medicare & Medicaid Services (CMS) has expanded the coverage for cochlear implantation to cover moderate-to-profound hearing loss in individuals with hearing test scores equal to or less than 40% correct in the best aided listening condition on tape-recorded tests of open-set sentence recognition and who demonstrate limited benefit from amplification.
In addition CMS is covering cochlear implantation for individuals with open-set sentence recognition test scores of greater than 40% to less than or equal to 60% correct but only when the provider is participating in, and patients are enrolled in, either:
• A Food and Drug Administration (FDA)-approved category B investigational device exemption (IDE) clinical trial; or
• A trial under the CMS clinical trial policy (see Pub. 100-03, section 310.1); or
• A trial under the CMS clinical trial policy (see Pub. 100-03, section 310.1); or
Healthcare Common Procedural Coding System (HCPCS)
The following HCPCS codes are some of those available for use when billing for cochlear implantation services and devices provided by audiologists or physicians, and for the services of 92506 and 92507, by speech language pathologists.
69930 – Cochlear device implantation, with or without mastoidectomy
L8614 – Cochlear Device/System
L8619 – Cochlear implant external speech processor, replacement
L7500 – Repair of prosthetic device, hourly rate (excludes V5335 repair of oral laryngeal prosthesis or artificial larynx)
L7510 – Repair of prosthetic device, repair or replace minor parts
92506 – Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status
92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual
92601 – Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming
(Codes 92601 and 92603 describe post-operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator. Codes 92602 and 92604 describe subsequent sessions for measurements and adjustment of the external transmitter and re-programming of the internal stimulator.)
69930 – Cochlear device implantation, with or without mastoidectomy
L8614 – Cochlear Device/System
L8619 – Cochlear implant external speech processor, replacement
L7500 – Repair of prosthetic device, hourly rate (excludes V5335 repair of oral laryngeal prosthesis or artificial larynx)
L7510 – Repair of prosthetic device, repair or replace minor parts
92506 – Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status
92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual
92601 – Diagnostic analysis of cochlear implant, patient under 7 years of age; with programming
(Codes 92601 and 92603 describe post-operative analysis and fitting of previously placed external devices, connection to the cochlear implant, and programming of the stimulator. Codes 92602 and 92604 describe subsequent sessions for measurements and adjustment of the external transmitter and re-programming of the internal stimulator.)
92602 – Diagnostic analysis of cochlear implant, patient under 7 years of age; subsequent programming. (Do not report 92602 in addition to 92601.)
92603 – Diagnostic analysis of cochlear implant, age 7 years or older; with programming
92604 – Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming
92603 – Diagnostic analysis of cochlear implant, age 7 years or older; with programming
92604 – Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming
