CurrentAmbetter NevadaPolicy CP.MP.14

Cochlear implant and external component replacements

Defines medical necessity criteria for replacement of cochlear implants and/or external cochlear implant components for members/enrollees of health plans affiliated with Centene Corporation (Ambetter Nevada). Applies to replacement and upgrades of devices and external parts.

Policy Summary

PayerAmbetter Nevada

PolicyCochlear implant and external component replacements

Policy CodePolicy CP.MP.14

Change TypeEditorial and coding updates

Effective Date

Next Review Date

Key ActionDocument device malfunction or irrepairability when claiming replacement, including failure diagnostics, repair attempts, or vendor service notes.

SourceLink

POLICY UPDATE CHANGES

Verbiage in I.C. changed to state that the reasonable useful life of a sound processor is not less than five years.

Added HCPCS code L8614 to coding section during most recent annual review.

3Primary medically necessary replacement criteria

>=5Minimum reasonable useful life for a sound processor

MultipleProcedure and supply codes listed

Medically Necessary and Not Medically Necessary Replacement Criteria

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Medically necessary replacement

Replacement of a cochlear implant(s) and/or its external components is considered medically necessary when ANY one of the following is present:

ANY of the following

The existing device(s) is no longer functional and cannot be repaired.
Includes internal and/or external components.
A change in the member/enrollee's condition makes the existing unit(s) inadequate for the hearing-related activities of daily living and improvement is expected with a replacement unit(s).
Clinical expectation of improvement must be present.
Reasonable useful life
- The existing component has reached the limit of its reasonable useful life.
- The reasonable useful life of a sound processor is not less than five years.>= 5 years
  Used as minimum benchmark for replacement based on age of processor.

Not medically necessary / Cosmetic or convenience upgrades

Replacement or upgrade is considered not medically necessary when requested only for convenience or to upgrade to newer technology while the existing device is properly functioning.

ALL of the following

Existing cochlear implant and/or external components are properly functioning.
Requested replacement/upgrade is solely for convenience or to obtain newer technology (no clinical inadequacy).

Relevant Procedure and Supply Codes

CPTCPT

69949

Unlisted procedure, inner ear

HCPCS - Cochlear device and external componentsHCPCS

L8614	Cochlear device, includes all internal and external components
L8615	Headset/headpiece for use with cochlear implant device, replacement
L8616	Microphone for use with cochlear implant device, replacement
L8617	Transmitting coil for use with cochlear implant device, replacement
L8618	Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement
L8619	Cochlear implant, external speech processor and controller, integrated system, replacement
L8621	Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each
L8622	Alkaline battery for use with cochlear implant device, any size, replacement, each
L8623	Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each
L8624	Lithium ion battery for use with cochlear implant device speech processor, ear level replacement, each

1–10 of 13

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Documentation and Billing Requirements

Documentation Required

Document device malfunction or irrepairability

When submitting a claim for replacement due to a non-functional device, document that the existing device cannot be repaired (for example: failure diagnostics, repair attempts, and vendor service notes).

69949
L8614
L8617
L8627

Documentation Required

Document clinical inadequacy and expected improvement

For replacements based on a change in the member/enrollee’s clinical condition, document how the current device is inadequate for hearing‑related activities of daily living and provide the rationale that replacement is expected to improve function.

L8619
L8627
L8628

Documentation Required

Document age of processor for useful life criterion

When requesting replacement based on reasonable useful life, include the original processor implant or supply date in the record to show the processor has reached at least a five‑year lifespan.

L8615
L8616
L8623
L8624

Clinical and Administrative Context

Cochlear implants are electronic hearing devices that bypass damaged inner-ear hair cells to directly stimulate the auditory nerve via implanted electrodes and an external processor and microphone. The system converts sound to electrical signals that activate the auditory nerve, allowing the brain to interpret those signals as hearing (see device components: microphone, external speech processor, transmitter/receiver/stimulator, and implanted electrodes).

Replacements of cochlear implants or their external components may be required for several reasons: device failure or malfunction that cannot be repaired (documented diagnostics or vendor service notes should support irrepairability); a change in the member/enrollee's clinical condition that renders the existing unit inadequate for hearing-related activities of daily living and where improvement is expected with replacement; or end of reasonable useful life of a component (for a sound processor this policy specifies a benchmark of not less than five years).

Bilateral cochlear implantation has been shown in multiple studies to provide improved outcomes on some measures — for example, better speech recognition in noise, improved sentence and word recognition, and advantages in localization for some users — but evidence is mixed across outcome domains. Bilateral implantation also carries important trade-offs: it may produce asynchronous neural stimulation if nerve survival is asymmetric, it doubles the surgical risks compared with a single implant, and it is associated with substantially higher cost.

Key Terms

Definitions

Reasonable useful lifeThe expected lifespan of a device component before replacement is considered reasonable; for a sound processor this policy specifies not less than five years.

External componentsParts of the cochlear implant system worn outside the body (e.g., speech processor, microphone, transmitter coil, controller, batteries).

Sound processor lifespan noteThe reasonable useful life of a sound processor is not less than five years (used as the minimum benchmark for replacement based on processor age).

Policy Changes and Review Notes

2025-05-25addedLatest

HCPCS code L8614 (Cochlear device, includes all internal and external components) was added to the coding section during the annual review.

07/22clarified

Verbiage in I.C. was changed to state that the reasonable useful life of a sound processor is not less than five years (minor rewording with no clinical significance).

Scope, Policy Number, and Stats

Scope & Policy Metadata

Policy numberCP.MP.14

SubjectCochlear implant and external component replacements

StatusCURRENT

Scope summaryDefines medical necessity criteria for replacement of cochlear implants and/or external cochlear implant components for members/enrollees of health plans affiliated with Centene Corporation (Ambetter Nevada). Applies to replacement and upgrades of devices and external parts.

Reasonable useful life of sound processor>= 5 years

Policy Summary

PayerAmbetter Nevada

PolicyCochlear implant and external component replacements

Policy CodePolicy CP.MP.14

Change TypeEditorial and coding updates

Effective Date

Next Review Date

Key ActionDocument device malfunction or irrepairability when claiming replacement, including failure diagnostics, repair attempts, or vendor service notes.

SourceLink

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