Cochlear Implant
DESCRIPTION
A cochlear implant provides direct electrical stimulation to the auditory nerve, bypassing the usual transducer cells that are absent or nonfunctional in deaf cochlea. The basic components of a cochlear implant include both external and internal components. The external components include a microphone, an external sound processor, and an external transmitter. The internal components are implanted surgically. An internal receiver is implanted within the temporal bone and an electrode array extends from the receiver into the cochlea. Sounds are picked up by the microphone and carried to the external sound processor. The processor transforms sound into coded signals that are then transmitted transcutaneously to the implanted internal receiver. The receiver converts the incoming signals to electrical impulses that are conveyed to the electrode array, resulting in stimulation of the auditory nerve.
POLICY
Unilateral or bilateral cochlear implantation for the treatment of sensorineural hearing loss is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Upgrades of an existing, functioning external system to achieve aesthetic improvement, such as smaller profile components or a switch from a body-worn, external sound processor to a behind-the-ear (BTE) model, are considered not medically necessary.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
MEDICAL APPROPRIATENESS
Unilateral or bilateral cochlear implantation for the treatment of sensorineural hearing loss is considered medically appropriate if ALL of the following criteria are met:
Individual is 12 months of age and older
Has bilateral severe to profound prelingual or postlingual sensorineural hearing loss (e.g., a hearing threshold of 70 decibels or greater)
Is free from otitis media or other active, unresolved ear disorders
Has accessible cochlear lumen structurally suited to implantation
Deafness is not due to lesions in the auditory nerve and acoustic areas of the central nervous system
Has cognitive ability to use auditory clues and a willingness to undergo a program of rehabilitation
Has radiographic evidence of cochlear development
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Bilateral cochlear implantation may be performed independently with separate implants and speech processors in each ear or with a single processor. However, no single processor for bilateral cochlear implantation has been approved by the FDA for use in the United States. In addition, single processors do not provide binaural benefit and may impair sound localization and increase the signal to noise ratio received by the cochlear implant.
A post-cochlear implant rehabilitation program is necessary to achieve benefit from the cochlear implant. The rehabilitation program consists of 6 to 10 sessions that last approximately 2.5 hours each. The rehabilitation program includes development of skills in understanding running speech, recognition of consonants and vowels, and tests of speech perception ability.
It is important to note that member benefits for hearing-related services and equipment can vary according to member eligibility on the date of service, benefit plan exclusions, limitations, other requirements, and criteria.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2010). Cochlear implant (7.01.05). Retrieved March 8, 2011 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Cochlear implantation (NCD 50.3, p. 2-36). Ingenix.
Litovsky, R. Y., Johnstone, P. M., Godar, S., Agrawal, S., Parkinson, A, Peters, R., et al. (2006). Bilateral cochlear implants in children: Localization acuity measured with minimum audible angle. Ear and Hearing, 27 (1), 43 - 59. (Level 4 Evidence - Independent)
National Institute for Health and Clinical Excellence (2009, January). Cochlear implants for children and adults with severe to profound deafness. Retrieved March 9, 2011 from http://www.nice.org.uk/nicemedia/live/12122/42854/42854.pdf.
U. S. Food and Drug Administration. (2001, August). Center for Devices and Radiological Health. MED-EL COMBI40 + Cochlear Implant System. Retrieved March 9, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf/P000025A.pdf.
Winifred S.Hayes. Medical Technology Directory. (2007 December; Last update search May 18, 2010). Cochlear Implantation. Retrieved March 8, 2011 from www.Hayesinc.com/subscribers. (83 articles and/ or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 4/1985
MOST RECENT REVIEW DATE: 11/19/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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