Medicare Makes Cochlear Implant Programming More Available

(ROCKVILLE, MD-July 2003) The Centers for Medicare and Medicaid Services (CMS) will now allow the diagnostic analysis and subsequent reprogramming of a cochlear implant to be performed in an audiologist's private office. The Centers' new position is a victory for cochlear implant recipients who have had to travel considerable distances to cochlear implant surgery centers for the programming of their hearing devices. Effective July 1, 2003, private practice audiologists can directly bill and receive Medicare reimbursement for cochlear implant analysis and reprogramming (CPT codes 92601, 92602, 92603 and 92604). And in medical centers, no physician supervision will be required.

ASHA worked with CMS to reverse the agency's position that the new codes were rehabilitative and therefore not billable for Medicare purposes by audiologists in private practice. Prior to appealing the Medicare policy, ASHA had received letters and input from cochlear implant surgeons and audiologists who believed performing cochlear implant programming services by independently practicing audiologists to be both safe and effective. As part of an update to the 2003 Medicare Physician Fee Schedule (Program Memorandum AB-03-07, Page 5), CMS confirmed that the new CPT codes are diagnostic in nature and therefore billable by independent audiologists. (The memorandum can be viewed on the CMS Web site at https://www.cms.hhs.gov/manuals/pm_trans/AB03070.pdf)

"We believe that this Medicare ruling will help to lower the costs and time incurred by cochlear implant recipients by providing greater access to audiologists for these important services," said Glenda Ochsner, PhD, ASHA President. "And we look forward to helping cochlear implant recipients find local, ongoing professional care by audiologists to better manage and optimize the use of these extraordinary devices that have brought the joy of hearing to so many adults and children."

Programming (also known as mapping) of the cochlear implant speech processor is critical to the safety and effectiveness of the cochlear implant system. This diagnostic procedure is performed only by audiologists after the initial fitting of the external speech processor and activation of the device 4-6 weeks after the implantation surgery. After this initial "tune up", speech processors are generally programmed from 10-20 times during the first year, and far less frequently thereafter. Frequenc y of the programming varies widely per patient depending on a number of factors, including the length of time the patient has been without hearing prior to implantation. Cochlear implant programming is combined with audiologic (or aural) rehabilitation (AR) services that are designed to optimize the benefit provided by the implant and improve the communication relationships affected by deafness. AR treatment is usually short-term (typically ranging from 10-30 hour- long sessions) and focus on auditory speech perception, managing difficult communication situations using assistive technology and communication strategies, as well as support counseling.

Audiologists are hearing health care professionals who specialize in preventing, identifying, and assessing hearing disorders as well as providing audiologic treatment including hearing aids and other assistive listening devices.

For a referral to a certified and licensed audiologist in your area, or for free information about cochlear implants and hearing loss, call ASHA's Action Center at 1-800-638-8255 or go to ASHA's Web site at https://www.asha.org.

ASHA is the national professional, scientific, and credentialing association for more than 110,000 audiologists, speech- language pathologists, and speech, language, and hearing scientists. Speech- language pathologists identify, assess, and treat speech and language problems including swallowing disorders. For more information, log on to ASHA's Web site at www.asha.org or call our Action Center at 1-800-638-8255.