CurrentCentenePolicy CP MP.14

Cochlear Implant Replacements

Defines medical necessity criteria for replacement of cochlear implants and/or external cochlear implant components for members/enrollees of Centene-affiliated health plans.

Policy Summary

PayerCentene

PolicyCochlear Implant Replacements

Policy CodePolicy CP MP.14

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain appropriate prior authorization and submit applicable CPT/HCPCS codes when replacement criteria are met.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

>=5reasonable useful life (years)

1CPT unlisted (69949)

multipleHCPCS L86xx codes

Coverage Criteria for Cochlear Implant Replacement

Covered Replacement Criteria

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

Medical necessity criteria: The existing device(s) is no longer functional and cannot be repaired

Medical necessity criteria: 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)

Medical necessity criteria: 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)

Not Medically Necessary

Policy Summary

PayerCentene

PolicyCochlear Implant Replacements

Policy CodePolicy CP MP.14

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain appropriate prior authorization and submit applicable CPT/HCPCS codes when replacement criteria are met.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding

CPT CodesCPT

69949

Unlisted procedure, inner ear

HCPCS CodesHCPCS

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

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Provider Actions and Billing Guidance

Prior Authorization

Prior Authorization Required

Prior Authorization Required: Obtain prior authorization when replacement or upgrade criteria are met. Ensure clinical documentation supports the reason for replacement (device nonfunctional/unrepairable, change in condition limiting activities of daily living with expected improvement after replacement, or device has reached reasonable useful life — sound processors generally not less than five years).

Prior authorization required when any medical necessity criteria are met
Document device failure, repair attempts, or clinical change in hearing needs
If replacement is requested because the device reached reasonable useful life, include device age (sound processors typically ≥5 years)

Documentation Required

Coding and Claim Submission Note

Provider action: Submit current, accurate coding and complete clinical documentation with the claim. Reference the most up-to-date professional coding guidance; inclusion of codes in this policy is informational only and does not guarantee payment.

Include supporting clinical notes and prior auth reference number with claims when applicable
Providers should verify code edits, bundling rules, and payer-specific billing instructions prior to submission

Denial Risk

Convenience / Upgrade Denial Risk

Provider action: Highlight — replacements or upgrades requested solely for convenience or to obtain newer technology are not medically necessary and are subject to denial.

Requests for upgrades without clinical justification may be denied
Provide clinical rationale demonstrating why the existing, properly functioning device is inadequate

Note

Provider action Callout

Preserve this separate actionable highlight from the source

Background

Sensorineural hearing loss results from dysfunction of the inner ear or auditory nerve. A cochlear implant bypasses damaged hair cells by delivering electrical stimulation directly to the auditory nerve through implanted electrodes, enabling perception of sound when conventional amplification is insufficient. Bilateral implantation can improve sound localization and speech understanding in noise, though it involves additional surgical risk and cost. The policy applies to replacement of implants or external components when medical necessity is met — for example, when devices are nonfunctional, inadequate for the member’s changed needs, or have reached the end of their reasonable useful life; the reasonable useful life of a sound processor is not less than five years.

OpenPayer

Cochlear Implant Replacements

Coverage Criteria for Cochlear Implant Replacement

Coding

Provider Actions and Billing Guidance

Definitions

Background