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COCHLEARBAHA REPLACEMENT PARTSService Authorization Required


CMNNone DURABLE NTMANUALOVERAGE AND LIMITATION CRITERIA/POLICIESEFFECTIVE JULY 1ST2014REVISED NOVEMBER2019Cochlear Implants and Auditory Osseointegrated Implants BAHA Replacement Parts/RepairREPLACEME

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Document on Subject : "COCHLEARBAHA REPLACEMENT PARTSService Authorization Required"— Transcript:

1 COCHLEAR/BAHA REPLACEMENT PARTSService A
COCHLEAR/BAHA REPLACEMENT PARTSService Authorization Required CMN: None DURABLE NT MANUAL OVERAGE AND LIMITATION CRITERIA/POLICIES EFFECTIVE: JULY 1 ST 2014 REVISED: NOVEMBER 2019 Cochlear Implants and Auditory Osseointegrated Implants (BAHA) Replacement Parts/Repair REPLACEMENT PARTS ONLY ND Medicaid does not reimburse the cost of the implant deviceor procedure for Cochlear/BAHAthrough the Durable Medical Equipment (DME) program. Indications and limitations of coverage and medical appropriateness:Coverage of cochlear/BAHA COCHLEAR/BAHA REPLACEMENT PARTSService Authorization Required CMN: None DURABLE MEDICAL EQUIPME NT MANUAL OVERAGE AND LIMITATION CRITERIA/POLICIES EFFECTIVE: JULY 1 ST 2014 REVISED: NOVEMBER 2019 Cochlear Implants and Auditory Osseointegrated Implants (BAHA) Replacement Parts/Repair Noncovered:Reimbursements for manufacturer’s upgrades will not be made. An upgrade of a speech processor to achieve aesthetic improvement, such as smaller profile components, or a switch from a bodyworn, external sound processor to a behindtheear (BTE) model or technological advances in hardware or a convenience are not considered medically necessary and will not be approved.V5241 as this dispensing fee is specific to hearing aids. HCPC/CPTcodes and frequency limitsbased on 1 unilateral implantor device (E1399) Orthotic and prosthetic supply, acc

2 essory, and/or service component of anot
essory, and/or service component of another L Code. (Specifically cochlear implant accessories such as ear hooks, ear bands, harnesses and magnets.) Allowable units based on review (L8691) Auditory osseointegrated device, external sound processor, replacementAllows 1 replacementevery 5year (L8692) Auditory osseointegrated device, external sound processor, used withoutosseo integration, body worn, includes headband or other means ofattachmentAllows 1 replacementevery 5year (L8621) Zinc battery replacement Cochlear implant deviceAllows 33 batteries per month (L8622) Alkaline battery, replacement,any size Cochlear implant deviceAllows 33 batteries per month (L8623)Lithium ion battery, replacement cochlear implant device speech processor, ear l evel Allows 1 battery every2 years (L8624)Lithium ion battery, replacement, cochlear implant device speech processor, ear level Allowsreplacements per year COCHLEAR/BAHA REPLACEMENT PARTSService Authorization Required CMN: None DURABLE MEDICAL EQUIPME NT MANUAL OVERAGE AND LIMITATION CRITERIA/POLICIES EFFECTIVE: JULY 1 ST 2014 REVISED: NOVEMBER 2019 Cochlear Implants and Auditory Osseointegrated Implants (BAHA) Replacement Parts/Repair (L7368) Battery recharger unit for lithium ion rechargeable batteriesAllowsreplacementevery 2 years (L8627)Cochlear implant, external speech processor, component replacement Allows 1 r

3 eplacementevery 3 years (L8628) Cochlear
eplacementevery 3 years (L8628) Cochlear implant, external controller component, replacementAllows replacementevery 2 years (L8619) Cochlear implant, external speech processor and controller, integrated system, replacementAllows 1 replacement every 3 years (L8616) Microphone for use with cochlear implant device, replacementAllows 1replacement per year (L8617) Transmitting coil for use with cochlear implant device, replacementAllowsreplacementevery 6 months (L8618) Transmitter cable for use with cochlear implant device, replacementAllows replacement every6 months (L8629) Transmitting coil and cable, integrated, replacement, cochlear implant deviceAllows 4 replacements per 6 months (L7520) Repair prosthetic device, labor component, per 15 minutesAllowable units is based on review (92700) Unlistedotorhinolaryngological procedureAllows 2 requests perdevice peryear COCHLEAR/BAHA REPLACEMENT PARTSService Authorization Required CMN: None DURABLE MEDICAL EQUIPME NT MANUAL OVERAGE AND LIMITATION CRITERIA/POLICIES EFFECTIVE: JULY 1 ST 2014 REVISED: NOVEMBER 2019 Cochlear Implants and Auditory Osseointegrated Implants (BAHA) Replacement Parts/Repair Date Revised Revision April 2017 Policy clarification related to replacement parts and repairs for listed HCPC codesand allowable. Added documentation requirements and non - covered items. January 1, 2018 Revised HCPC co

4 des L8624, L7368, L8627, L8628, L8619, L
des L8624, L7368, L8627, L8628, L8619, L8617 , L8618 allowable . November 27, 2019Deletedfrom paragraph 1: FOR INITIAL APPROVAL FOR COCHLEAR/BAHA:ND Medicaid does not reimburse the cost of the implant device through the Durable Medical Equipment (DME) program. The cost of the deviceis covered by the usual reimbursement methodology for either inpatient or outpatient hospital services and must be billed by the hospital. NDMedicaid does not cover additional benefits for the device if the surgical procedure is performed in any other outpatient setting.lease view ND Medicaid's Policy for Revenue code 278 Supply/Other Implants at:http://www.nd.gov/dhs/services/medicalserv/medicaid/docs/revcodepolicy.pdf.Service authorization of the surgery and device must be received by the Medical Services department prior to he procedure taking place usingMedical Procedure/Device Prior Authorization Request Form SFN 511 at: http://www.nd.gov/eforms/This form must be completed in its entirety and all applicable documentation must be attached and reviewed Medical Services.Added to paragraph 1: ND Medicaid does not reimburse the cost of the implant deviceor procedure for Cochlear/BAHAthrough the Durable Medical Equipment (DME) program. eleted L9900 and replaced with E1399. Added CPT code 92700 with allowable for BAHA programming. Added to overed sectionV5241as this dispensing fee is specific to hearing aids. Updated logo with new lo