CurrentHealth NetPolicy CP.MP.14

Cochlear Implant Replacements (PDF)

Defines medical necessity criteria for replacement of cochlear implants and/or external components (speech processor, controller, microphones, coils, batteries, etc.) and states when replacement or upgrade of properly functioning devices is not medically necessary.

Policy Summary

PayerHealth Net

PolicyCochlear Implant Replacements (PDF)

Policy CodePolicy CP.MP.14

Change TypeRevised (coding added)

Effective Date

Next Review Date

Key ActionProvider must document that one of the medical necessity criteria is met: device nonfunctional and not repairable; change in condition rendering device inadequate with expectation of improvement after replacement; or component has reached reasonable useful life (≥ five years for sound processors).

SourceLink

POLICY UPDATE CHANGES

Annual review completed May 2025; added CPT L8614 and updated coding/descriptions.

Multiple prior annual reviews updated wording for reasonable useful life and minor wording changes with no clinical significance.

3Medically necessary scenarios listed

1Not medically necessary scenario

15HCPCS/CPT codes referenced

Coverage Summary

Defines medical necessity criteria for replacement of cochlear implants and/or external components (speech processor, controller, microphones, coils, batteries, etc.). Replacement is considered medically necessary when any one of the following is met: device nonfunctional and not repairable; a change in the member/enrollee's condition renders the device inadequate with expected improvement after replacement; or the component has reached its reasonable useful life (sound processors: not less than five years). Replacement or upgrade of a properly functioning device requested only for convenience or to upgrade to newer technology is considered not medically necessary. This policy has a mixed coverage stance and is intended as a guide to medical necessity and coverage administration; it does not supersede applicable state Medicaid provisions or Medicare determinations.

Policy metadata and thresholds

Policy NumberCP.MP.14

SubjectCochlear implant replacements

StatusCURRENT

Last review2025-05-25

Effective date

Next review

ThresholdSound processor reasonable useful life = not less than five years

Medical Necessity Criteria for Replacement

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 met:

Medically Necessary Replacement - top level

Device nonfunctional: The existing device(s) is no longer functional and cannot be repaired.
Change in condition: 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).
Reasonable useful life reached: 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.

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Not Medically Necessary

Replacement or upgrade is considered not medically necessary when requested only for:

Not Medically Necessary - convenience/upgrade: Convenience or to simply upgrade to a newer technology when the existing cochlear implant and/or its external components are properly functioning.

Coding (informational)

CPT codes (informational)CPT

69949

Unlisted procedure, inner ear

HCPCS codes - Cochlear implant devices and external replacement components (informational)HCPCS

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 & Billing Guidance

Documentation Required

Document reason for replacement

Provider must document that one of the medical necessity criteria is met: device nonfunctional and not repairable; change in condition rendering device inadequate with expectation of improvement after replacement; or component has reached reasonable useful life (sound processors: not less than five years).

Existing device is no longer functional and cannot be repaired.
Change in member/enrollee condition makes the existing unit inadequate and improvement is expected with replacement.
Existing component has reached the limit of its reasonable useful life (reasonable useful life for sound processors not less than five years).

Billing Rule

Use informational CPT/HCPCS codes

When billing for cochlear implant replacements, providers should reference the listed CPT and HCPCS codes and follow current coding guidance; codes included are informational and inclusion does not guarantee coverage.

69949
L8614
L8615
L8616
L8617
L8618
L8619
L8621
L8622
L8623
L8624
L8627
L8628
L8629

Operational note: Reference Medicare Local Coverage Article A53708 (billing and coding: external components for cochlear implants), effective 2015-10-01 (revised 2019-11-07) for Medicare billing/coding guidance. This policy does not supersede state Medicaid coverage provisions or Medicare NCDs/LCDs; providers should review applicable Medicare determinations and state Medicaid manuals prior to applying these criteria.

Background & Evidence

Background: A cochlear implant consists of four basic components: an external microphone, an external speech processor, a transmitter/receiver-stimulator, and implanted electrode array that stimulates the auditory nerve. Cochlear implants bypass damaged hair cells and directly stimulate the auditory nerve; the brain then learns to interpret these signals as sound. Cochlear implants have been studied since the 1950s and were approved by the FDA in adults in the mid-1980s. NIH scientists determined cochlear implants to be cost beneficial. Recent studies comparing bilateral versus unilateral implants show improved hearing thresholds and better speech recognition in noise for bilateral users, though outcomes in quiet are mixed; bilateral implantation may improve localization and some speech outcomes but is associated with doubled surgical risk and substantially increased cost. This clinical policy is intended as a guide to medical necessity and does not supersede state Medicaid provisions or Medicare determinations.

Evidence summary (NIH / historical approval): Cochlear implants were studied beginning in the 1950s, received FDA approval for adults in the mid-1980s, and the National Institutes of Health determined cochlear implants to be cost beneficial.

Definitions:

Reasonable useful life: For sound processors, not less than five years.

Member/enrollee: Terminology used interchangeably in the policy to refer to the insured individual.

Name	Number	Effective	Type
Local coverage article: billing and coding: external components for cochlear implants	A53708	2015-10-01; revised 2019-11-07	LCD

Revision History

05/25/2025revision/approvalLatest

Annual review completed May 2025; coding reviewed and L8614 added; references updated; reviewed by external specialist.

06/24revision/approval

Annual review. Updated description and background with no clinical significance. Coding reviewed, updated description for L8623. References reviewed and updated. Added CPT L8614. Reviewed by external specialist.

07/23revision/approval

Annual review. Updated description and background with no clinical significance. Coding reviewed, updated description for L8623. References reviewed and updated. External specialist reviewed.

07/22revision/approval

Annual review completed. Minor rewording (I.C. verbiage change) with no clinical significance. Background updated with no impact to criteria. References reviewed and updated. External specialist reviewed.

07/21revision/approval

Annual review completed. Removed 'or' in I.A. and I.B.; background updated with no impact to criteria. References reviewed and updated.