Skip to main content
U.S. flag

An official website of the United States government

Here’s how you know

Dot gov

The .gov means it’s official.

Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.

The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

    CMS.gov Centers for Medicare & Medicaid Services CMS.gov Centers for Medicare & Medicaid Services opens in new window
    CMS.gov Centers for Medicare & Medicaid Services
    Centers for Medicare & Medicaid Services

    Main header

    • About Us
    • Newsroom
    • Data & Research
    MCD
    Medicare Coverage Database
    • Advanced Search
    • Indexes
    • Reports
    • Downloads
    • National Coverage
      • National Coverage Analyses (NCAs)
        • Open NCAs
        • Closed NCAs
      • Coding Analyses for Labs (CALs)
        • Closed CALs
      • National Coverage Determinations (NCDs)
        • NCDs Listed Alphabetically
        • NCDs by Chapter/Section
        • Lab NCDs
      • Meetings & Assessments
        • MEDCAC Meetings
        • Technology Assessments
      • Medicare Coverage Documents
        • CMS Solicitation of Public Comments.
        • Compendia
        • Expedited Process to Remove National Coverage Determinations
        • Guidance Documents
        • National Benefit Category Analyses
        • Potential National Coverage Determination (NCD) Topics
    • Local Coverage
      • Local Coverage Determinations (LCDs)
        • LCDs by Contractor
        • LCDs by State
        • LCDs Listed Alphabetically
      • Articles
        • Articles by Contractor
        • Articles by State
        • Articles Listed Alphabetically
      • Contacts
        • All Contacts Listed Alphabetically
        • Contacts for Part A - Medicare Administrative Contractor (MAC - Part A)
        • Contacts for Part B - Medicare Administrative Contractor (MAC - Part B)
        • Contacts for Durable Medical Equipment Medicare Administrative Contractor (DME MAC)
        • Contacts for Home Health & Hospice (HHH)
    • National Coverage
      • What's New Report
      • Annual Report
    • Local Coverage
      • What's New Report
      • LCD Status Report
      • Proposed LCD Status Report
      • LCD Last Updated Report
      • Article Status Report
      • SAD Exclusion List Report
    0
    • Help & Resources
    • Page Help opens in new window
    • Contact Us

    MCD

    National Coverage Determination (NCD) for Cochlear Implantation (50.3)

    Select the Print Complete Record, Add to Basket or Email Record Buttons to print the record, to add it to your basket or to email the record.
    • Expand All All sections on the page are Expanded
    • Collapse All All sections on the page are Collapsed

    Collapse Tracking Information

    Publication Number

    100-3

    Manual Section Number

    50.3

    Manual Section Title

    Cochlear Implantation


    Version Number

    2

    Effective Date of this Version

    4/4/2005

    Implementation Date

    7/25/2005


    Collapse Description Information


    Benefit Category
    Prosthetic Devices

    Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

    Item/Service Description

    A. General

    A cochlear implant device is an electronic instrument, part of which is implanted surgically to stimulate auditory nerve fibers, and part of which is worn or carried by the individual to capture, analyze, and code sound. Cochlear implant devices are available in single-channel and multi-channel models. The purpose of implanting the device is to provide awareness and identification of sounds and to facilitate communication for persons who are moderately to profoundly hearing impaired.


    Indications and Limitations of Coverage

    B. Nationally Covered Indications

    1. Effective for services performed on or after April 4, 2005, cochlear implantation may be covered for treatment of bilateral pre- or-post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of less than or equal to 40% correct in the best-aided listening condition on tape-recorded tests of open-set sentence cognition. Medicare coverage is provided only for those patients who meet all of the following selection guidelines.

    • Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
    • Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
    • Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
    • No contraindications to surgery; and
    • The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling.

    2. Effective for services performed on or after April 4, 2005, cochlear implantation may be covered for individuals meeting the selection guidelines above and with hearing test scores of greater than 40% and less than or equal to 60% only when the provider is participating in, and patients are enrolled in, either an FDA-approved category B investigational device exemption clinical trial as defined at 42 CFR 405.201, a trial under the Centers for Medicare & Medicaid (CMS) Clinical Trial Policy as defined at section 310.1 of the National Coverage Determinations Manual, or a prospective, controlled comparative trial approved by CMS as consistent with the evidentiary requirements for National Coverage Analyses and meeting specific quality standards.

    C. Nationally Non-Covered Indications

    Medicare beneficiaries not meeting all of the coverage criteria for cochlear implantation listed are deemed not eligible for Medicare coverage under section 1862(a)(1)(A) of the Social Security Act.

    D. Other

    All other indications for cochlear implantation not otherwise indicated as nationally covered or non-covered above remain at local Medicare Administrator Contractor discretion.


    Cross Reference

    CED page


    Claims Processing Instructions
    • TN 601 (Medicare Claims Processing)

    Collapse Transmittal Information

    Transmittal Number

    42

    Coverage Transmittal Link

    https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R42NCD.pdf

    Revision History

    09/1986 - Provided coverage for post-lingual deaf adults. Effective date 10/01/1986. (TN 10)

    12/1992 - Allowed coverage for children ages 2 through 17 with bilateral profound sensorineural hearing impairment and demonstrate little or no benefit from a hearing aid. Effective date 12/31/1992. (TN 64)

    04/1998 - Updated coverage policy consistent with changes in technology and FDA labeling for product, and expanded coverage for children and adults. Effective date 05/01/1998. (TN 104) (CR 390)

    07/2005 - Expanded coverage to cover moderate-to-profound hearing loss in individuals with specified hearing test scores. Effective date 04/04/2005. Implementation date 07/25/2005. (TN 42) (CR 3796)

    03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015. (TN 1199) (TN 1199) (CR 8197)

    05/2014 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/06/2014 Effective date: 10/1/2015. (TN 1388) (TN 1388) (CR 8691)

    05/2016 - This change request (CR) is the 7th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, and CR9540. Some are the result of revisions required to other NCD-related CRs released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. (TN 1665) (CR9631)

    06/2016 - Transmittal 1665, dated May 13, 2016, is being rescinded and replaced by Transmittal 1672 to: (1) 9631.1: Remove FISS responsibility and 1st sentence; (2) 9631.2: Remove additional procedure codes, including 0075T, 0076T; (3) 9631.4: Revise descriptor of dx L59.8; (4) 9631.6: Add deletion of dx C49.10, C65.9, remove deletion of dx C54.9, remove deletion of invalid dx C47.90; (5) 9631.8: Remove deletion of invalid dx C51.29, replace with deletion of dx C50.029; (6) 9631.9: Add deletion of 0V504ZZ, 0V500ZZ, override capability, and contractor discretion verbiage. All other information remains the same. (TN 1672) (CR9631)

    07/2020 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 10261) (CR11905)


    Collapse National Coverage Analyses (NCAs)

    National Coverage Analyses (NCAs)

    This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

    • Original consideration for Cochlear Implantation (CAG-00107N) opens in new window

    Expand/Collapse the Additional Information section Additional Information

    Other Versions
    • Cochlear Implantation - Version 1, Effective between 5/1/1998 - 4/4/2005
    Footer Links
    • Submit Feedback/Ask a Question
    98

    Get email updates

    Sign up to get the latest information about your choice of CMS topics in your inbox. Also, you can decide how often you want to get updates.

    CMS & HHS WEBSITES

    • Medicare.govopens in new window
    • MyMedicare.govopens in new window
    • Medicaid.govopens in new window
    • InsureKidsNow.govopens in new window
    • HealthCare.govopens in new window
    • HHS.govopens in new window

    HELPFUL LINKS

    • Acronyms
    • Archive
    • Contacts
    • Glossary
    • Privacy policy

    RSS FEEDS

    • Newsroom
    • Blog
    • Podcast
    U.S. Department of Health & Human Servicesopens in new window Centers for Medicare & Medicaid Servicesopens in new window

    A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.

    7500 Security Boulevard, Baltimore, MD 21244

    opens in new window opens in new window opens in new window

    TOOLS

    • Web policiesopens in new window
    • Plain languageopens in new window
    • No Fear Actopens in new window
    • Freedom of Information Actopens in new window
    • Inspector Generalopens in new window