Article - Billing and Coding: External Components for Cochlear Implants (A53708)

CMS National Coverage PolicyN/AArticle TextA cochlear implant system consists of both internal (implanted) and external components. The external components consist of a microphone, sound processor and a transmitter.Replacement of cochlear implant components not otherwise covered under a manufacturer's warranty:There are very few mechanical problems associated with cochlear implants, and replacement of existing components due to device failure occurs infrequently. However, there have been many revisions and upgrades to the various components leading to improvements in design and speech perception. Replacement of an existing, functioning cochlear implant component is covered only when a physician certifies that:The existing component is ineffective to the point of interfering with the activities of daily living, orWhen there is a change in the patient's medical condition necessitating a different type of component, orThe existing component has reached its reasonable useful life. The reasonable useful life of a sound processor is not less than 5 years.Replacement or upgrades of existing, functioning cochlear implants or cochlear implant components for any reason before the component has reached its reasonable useful life are not covered by Palmetto GBA. For example, upgrading to next generation, smaller profile external components, or switching from a body worn sound processor to a behind-the-ear model is considered a convenience.Supplies or accessories that are not necessary for the functioning of the cochlear implant, such as cell phone adapters, telecoils, carrying cases, keychain wallets, or car charger adapters, and accessories and upgrades to accommodate personal convenience or deluxe items are not covered by Palmetto GBA. Accessories and supplies should be reported with HCPCS code L9900.When replacing headset/headpiece, microphone, transmitting coil or transmitter cable for use with cochlear implant device, the correct HCPCS code should be used instead of L7510.When a repair is being done on a prosthetic device, the labor component is billed with HCPCS code L7520. Each billable unit represents 15 minutes of labor time. Documentation should include the original purchase date of the item repaired, the reason for repair, the item repaired, the functionality of the item repaired and the invoice cost from the manufacturer. The specific items repaired should be documented with invoice cost and the specific parts repaired. Repairs and replacement of minor parts and pieces can be billed under code L7510. Replacement items can be billed under L7510 if no other code is suitable.DO NOT BILL ACCESSORIESunder code L7510. Labor cost does not apply when items are being replaced.Battery Quantity Limit Per ImplantHCPCS CodePer MonthPer 3 MonthsOtherL86213090N/AL862260180N/AL8623N/AN/A4 per 12 monthsL8624N/AN/A4 per 36 monthsFor any exceptions please submit the appropriate narrative in item #19 claim field of the electronic 5010 form or on an attachment for paper claims.Following is an example of items classified as convenience and not necessary for the functionality of the Cochlear Implant device and are considered an accessory to be billed under code L9900:Attachment/Connection/Safety ClipsAudio Interface DeviceCar AdaptersCable AdaptersEar Hook PinsDaCapo Extension KitsDrying supplies - Manual/ElectricalFine Tuner/Fine Tuner BatteriesFixation BarMini Battery PacksMicrophone Tester Device KitDevice ProtectorsRemote Battery PacksRepair KitsTelephone AdapterT Mic MicrophoneFollowing is an example of items that are considered a major part of the device and should be billed under the specific L code listed in theCPT/HCPCS Codetable provided below:BatteriesCablesCoilsControllersHeadsetsMicrophonesProcessorsThe following items are considered a major part of the device and would be replaced every three years for reasonable use:Battery ChargersBattery PacksEar HookMicrophone coverNote:When billing the items listed above include the original purchase date of the device, the last replacement date of the item billed and the reason for replacement.