CMS moving to expand Medicare coverage of cochlear implants

Transplant News,  Jan 15, 2005  

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The federal government has taken a big step towards expanding its coverage of cochlear implant devices.

The Centers for Medicare and Medicaid Services (CMS) announced on January 7 it will propose an expansion of current Medicare coverage of the devices by lowering the threshold potential beneficiaries would have to meet to get cured of their deafness.

Currently, Medicare covers cochlear implants for beneficiaries with severe sensorineural hearing loss, which is determined by a sentence recognition test administered in the patient's best listening condition.

Under current policy, the patient must demonstrate a test score of 30% or less on the sentence recognition. CMS said the current policy was based in part on previous US Food and Drug Administration (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% or less correct on tape-recorded tests of open set sentence recognition in the ear to be implanted.

In addition, Medicare would cover cochlear implants in beneficiaries who have test scores over 40% and up to and including 60% if they are participating in a Medicare approved clinical trial of cochlear implantation.

CMS emphasized in a press release announcing the intent to expand coverage that a vast majority of people with hearing loss to not have sensorineural deafness for which a cochlear implant can provide a benefit.

The form of hearing loss or nerve deafness that will benefit from an implant 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 Web site - www.cms.hhs.gov/coverage. The January 7 posting 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.

Contact: 1-800-MEDICARE or the CMS Office of Public Affairs - (202) 690-6145.

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