Medicare Expands Acceptance Criteria for Cochlear
Implants
April 2005
Editor: As you may know, various agencies and insurers have differing
requirements for the degree of hearing loss required for a candidate to
qualify for a cochlear implant (CI). The Medicare threshold has remained
for years at 30% on an open-set sentence recognition test, while other
organizations have increased the amount of hearing a candidate may have
and still qualify for a CI. On April 7 the standard threshold was
increased to 40%, with up to 60% allowable for clinical trials. Here's
the notice from the Centers for Medicare & Medicaid Services.
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The Centers for Medicare & Medicaid Services (CMS) announced
today that it will expand coverage of cochlear implant devices to help
treat severe hearing loss and will cover an additional oral drug to
treat chemo-therapy induced vomiting.
CMS is expanding current coverage for cochlear implants, which are
used to treat bilateral pre-or-post linguistic, sensorineural, moderate
to profound severe hearing loss. Previously, Medicare covered cochlear
implants for beneficiaries with open-set sentence recognition test
scores of 30 percent correct or worse.
Under today's decision, Medicare will cover cochlear implants in
beneficiaries who have test scores of 40 percent or less correct, and
will cover cochlear implants in beneficiaries who have open-set sentence
recognition test scores over 40 percent up to 60 percent if they are
participating in a clinical trial of cochlear implantation that meets
the requirements outlined in the national coverage decision.
"This decision provides a way to better quality of life for many
beneficiaries who did not previously qualify for Medicare coverage of a
cochlear implant, and it will help us learn whether even more can
benefit significantly," said CMS Administrator Mark McClellan, MD,
PhD.
[snipped the information about the oral drug to treat chemo-therapy
induced vomiting]
These final coverage decisions are available for review at the CMS
coverage website www.cms.hhs.gov/coverage. The decisions are effective
today.
