LCD Reference Article Billing and Coding Article

Billing and Coding: External Components for Cochlear Implants

A53708

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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General Information

Source Article ID
N/A
Article ID
A53708
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: External Components for Cochlear Implants
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
11/07/2019
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

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Article Guidance

Article Text

A 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:
    1. The existing component is ineffective to the point of interfering with the activities of daily living, or
    2. When there is a change in the patient's medical condition necessitating a different type of component, or
    3. The 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 ACCESSORIES under code L7510. Labor cost does not apply when items are being replaced.

Battery Quantity Limit Per Implant

HCPCS Code Per Month Per 3 Months Other
L8621 30 90 N/A
L8622 60 180 N/A
L8623 N/A N/A 4 per 12 months
L8624 N/A N/A 4 per 36 months



For 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 Clips
  • Audio Interface Device
  • Car Adapters
  • Cable Adapters
  • Ear Hook Pins
  • DaCapo Extension Kits
  • Drying supplies - Manual/Electrical
  • Fine Tuner/Fine Tuner Batteries
  • Fixation Bar
  • Mini Battery Packs
  • Microphone Tester Device Kit
  • Device Protectors
  • Remote Battery Packs
  • Repair Kits
  • Telephone Adapter
  • T Mic Microphone


Following 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 the CPT/HCPCS Code table provided below:

  • Batteries
  • Cables
  • Coils
  • Controllers
  • Headsets
  • Microphones
  • Processors


The following items are considered a major part of the device and would be replaced every three years for reasonable use:

  • Battery Chargers
  • Battery Packs
  • Ear Hook
  • Microphone cover


Note: 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.

Response To Comments

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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/07/2019 R7

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under Article Title changed the title from “Billing and Coding: Billing and Coding External Components for Cochlear Implants” to “Billing and Coding: External Components for Cochlear Implants”. Typographical errors were corrected throughout the article.

04/01/2018 R6

Under CPT/HCPCS Group 1: Codes, added HCPCS code L7520.

02/26/2018 R5 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these three contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
01/01/2018 R4

Under CPT/HCPCS Codes Group 1 descriptions were revised for CPT codes L8618 and L8624. This revision is due to the Annual CPT/HCPCS Code Update.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 

03/16/2017 R3 Under Article Text change verbiage under ninth paragraph, replace “Audio Interface Code” with “Audio Interface Device”, typographical correction to read “Cable Adapters” and “Fine Tuner/Fine Tuner Batteries”.
02/25/2016 R2 Under Article Text in the second sentence of the first paragraph deleted the “s” from “consist”. In the second paragraph bullet deleted “…replacement of…” as this is redundant. In the first sentence of the fourth paragraph deleted “and”. In the last sentence of the sixth paragraph deleted “Replacement of functional parts, e.g. screws” as this is an incomplete sentence. In the seventh paragraph revised the narrative to indicate the appropriate electronic claim field for documenting exceptions for the battery quantity limit per implant. In the ninth paragraph added the verbiage “CPT/HCPCS Code”.
10/01/2015 R1 Under Associated Documents, CMS Manual Explanations Url(s) added CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Ch. 1, §50.3.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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SAD Process URL 1
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Public Versions
Updated On Effective Dates Status
10/30/2019 11/07/2019 - N/A Currently in Effect You are here
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