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Program Name: BadgerCare Plus and Medicaid Handbook Area: Hearing
04/18/2014  

Covered and Noncovered Services : Codes

Topic #471

Cochlear Implant and Bone-Anchored Hearing Aid Surgeries

Allowable Procedure Codes for Billing Cochlear Implant and Bone-Anchored Hearing Aids

Providers should use the following procedure code information when billing for and submitting PA requests for cochlear implants and bone-anchored hearing aids.

Cochlear Implant Hearing Devices
Procedure Code Procedure Code Description PA Always Required Life Expectancy Covered in Nursing Home Copayment Bilateral Place of Service Provider Type
L8614 Cochlear device, includes all internal and external components No 10 years No $3.00 No 22, 24 25
L8619 Cochlear implant, external speech processor and controller, integrated system, replacement No 3 years No $3.00 No 11 20, 25, 31, 33, 74

Bone-Anchored Hearing Aids
Procedure Code Procedure Code Description PA Always Required Life Expectancy Covered in Nursing Home Copayment Bilateral Place of Service Provider Type
L8690 Auditory osseointegrated device, includes all internal and external components No 5 years No $3.00 No 22, 24 25
L8692 Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of attachment Yes 5 years No $3.00 No 11 20, 25, 74

Allowable Place of Service Codes and Provider Types for Billing Cochlear Implant and Bone-Anchored Hearing Aids (Procedure Codes L8614, L8619, and L8692)
Allowable Place of Service Codes

11 - Office
22 - Outpatient Hospital
24 - Ambulatory Surgical Center

Provider Types

20 - Audiologists
25 - Medical Equipment Vendors
31 - Physicians
33 - Physician Clinics
74 - Speech and Hearing Clinics

Allowable Procedure Codes for Billing Cochlear Implant and Bone-Anchored Hearing Aid Replacement Parts

Providers should use the following procedure code information when billing for cochlear implant and bone-anchored hearing aid replacement parts.

Note: Wisconsin Medicaid assigns "U" modifiers to multiple items listed on PA requests to indicate separate approval of DME (i.e., accessories).

Cochlear Implant and Bone-Anchored Hearing Aid Replacement Parts
Procedure Code Procedure Code Description PA Always Required Life Expectancy Covered in Nursing Home Copayment Bilateral Place of Service Provider Type
L7510 Repair of prosthetic device, repair or replace minor parts Yes, if the repair or parts exceed $150.00 Varied Yes $0.00 No 11, 12, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
L8615 Headset/headpiece for use with cochlear implant device, replacement Yes 1 per 3 years Yes $3.00 No 11, 12, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
L8616 Microphone for use with cochlear implant device, replacement Yes 1 per year Yes $3.00 No 11, 12, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
L8617 Transmitting coil for use with cochlear implant device, replacement Only if over $150.00 4 per 6 months Yes $1.00 No 11, 12, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
L8618 Transmitter cable for use with cochlear implant device, replacement Only if over $150.00 4 per 6 months Yes $1.00 No 11, 12, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
L8691 Auditory osseointegrated device, external sound processor, replacement No 5 Years Yes $3.00 No 11, 31, 32 04, 17, 20, 24, 25, 74, 75, 77, 79
V5266 Battery for use in hearing device No 72 per 6 months Yes $0.50 No 11, 12, 31, 32 No provider restrictions

Allowable Place of Service Codes Provider Types
11 - Office
12 - Home
31 - Skilled Nursing Facility
32 - Nursing Facility
04 - Rehabilitation Agencies
17 - Therapy Groups
20 - Audiologists
24 - Pharmacies
25 - Medical Equipment Vendors
74 - Speech and Hearing Clinics
75 - Federally Qualified Health Centers
77 - Physical Therapists
79 - Speech-Language Pathologists

Replacement Parts for Cochlear Implant and Bone-Anchored Hearing Aids

The following cochlear implant device and bone-anchored hearing aid replacement parts are reimbursable under procedure codes L8615, L8616, L8617, L8618, and L7510.

Cochlear Implant Devices
Replacement Parts Life Expectancy
Battery charger kit 1 per 3 years
Cochlear auxiliary cable adapter 1 per 3 years
Cochlear belt clip 1 per 3 years
Cochlear harness extension adapter 1 per 3 years
Cochlear signal checker 1 per 3 years
Disposable batteries for ear-level processors 72 per 6 months
Headset (three-piece component) 1 per 3 years
Headset cochlear coil (individual component) 1 per year
Headset cochlear magnet (individual component) 1 per year
Headset microphone (individual component) 1 per year
Headset cable or cord 4 per 6 months
Microphone cover 1 per year
Pouch 1 per year
Rechargeable batteries (per set of two) 1 per year
Transmitter cable or cord 4 per 6 months
 
Bone-Anchored Hearing Aids
Replacement Parts Life Expectancy
Headband 1 per year
Batteries 72 per 6 months
Processor 1 per 5 years
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