National Coverage Determination (NCD)

Cochlear Implantation

50.3

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Tracking Information

Publication Number
100-3
Manual Section Number
50.3
Manual Section Title
Cochlear Implantation
Version Number
1
Effective Date of this Version
05/01/1998
Ending Effective Date of this Version
04/04/2005

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 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 an awareness and identification of sounds and to facilitate communication for persons who are profoundly hearing impaired.

Indications and Limitations of Coverage

Medicare coverage is provided only for those patients who meet all of the following selection guidelines.

A - General

  • Diagnosis of bilateral severe-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 withe the FDA-approved labeling.

B - Adults

Cochlear implants may be covered for adults (over age 18) for prelinguistically, perilinguistically, and postlinguistically deafened adults. Postlinguistically deafened adults must demonstrate test scores of 30 percent or less on sentence recognition scores from tape recorded tests in the patient's best listening condition.

C - Children

Cochlear implants may be covered for prelinguistically and postlinguistically deafened children aged 2 through 17. Bilateral profound sensorineural deafness must be demonstrated by the inability to improve on age appropriate closed-set word identification tasks with amplification.

Transmittal Information

Transmittal Number
104
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)

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.

Additional Information

Other Versions
Title Version Effective Between
Cochlear Implantation 2 04/04/2005 - N/A View
Cochlear Implantation 1 05/01/1998 - 04/04/2005 You are here