Currently, CMS has a National Coverage Determination (NCD 50.3) covering cochlear implantation 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 = 40% correct in the best-aided listening condition on tape recorded tests of open-set sentence cognition. For individuals with hearing test scores of > 40 % and = 60 %, CMS covers cochlear implantation only when the provider is participating in and patients are enrolled in a clinical study.
CMS received a complete, formal request to reconsider the NCD. This NCD analysis will align with the scope of the request and focus on individuals with hearing test scores of > 40% and ≤ 60 %, for whom coverage is available only when the provider is participating in and patients are enrolled in a clinical study.
CMS is soliciting public comment on this topic. We are particularly interested in any peer-reviewed literature that describes the sentence recognition of individuals who experience bilateral pre-or post-linguistic, sensorineural, moderate-to-profound hearing loss within the boundaries of pre- implantation hearing test scores of > 40 % and ≤ 60 %.
