The Centers for Medicare & Medicaid Services (CMS) announced today that it will propose an expansion of current Medicare coverage for cochlear implant devices.
A draft national coverage decision posted on the CMS web site today would lower the threshold for Medicare coverage of the implants.
“This is a welcome change for many beneficiaries who did not previously qualify for Medicare coverage of a cochlear implant,” said CMS Administrator Mark McClellan, MD, PhD.
Currently, Medicare covers cochlear implants for beneficiaries with severe sensorineural hearing loss, which is determined by a sentence recognition test that is administered in the patient’s best listening condition.
Under current policy, the patient must demonstrate a test score of 30 percent or less on the sentence recognition. This policy was based in part on previous FDA approved labeling, which has been updated recently.
Under the proposed new policy, Medicare would cover cochlear implants in beneficiaries who have test scores of 40 percent or less correct in the ear to be implanted on tape-recorded tests of open set sentence recognition.
In addition, Medicare would cover cochlear implants in beneficiaries who have test scores over 40 percent up to and including 60 percent if they are participating in a Medicare approved clinical trial of cochlear implantation.
It is estimated that more than 25 million Americans have hearing loss, including one out of four people older than 65.
The vast majority of people with hearing loss do not have sensorineural deafness for which cochlear implant can provide benefit. This form of hearing loss or nerve deafness results when delicate portions of the inner ear known as hair cells have been damaged and fail to perform their function of converting sound waves into electrical current that the brain recognizes as sound.
A cochlear implant, which is an electronic device surgically placed under the skin, bypasses the hair cells and directly transmits sounds through electrodes that stimulate the auditory nerve.
The proposed coverage policies are available for review at the CMS coverage website (www.cms.hhs.gov/coverage). The posting of this proposed coverage policy marks the beginning of a 30-day public comment period. After close of the comment period, CMS will have 60 days to review the comments and issue a final policy.