CMS Publishes Expanded Coverage for Cochlear Implants Under Medicare

CMS Publishes Expanded Coverage for Cochlear Implants Under Medicare 

9/26/2022

On September 26, the Centers for Medicare & Medicaid Services (CMS) published details on its decision to expand coverage for cochlear implants under Medicare.  This provides a significant improvement in access to care for older adults who are Medicare beneficiaries allowing individuals with hearing test scores between >40% and ≤60% to qualify for cochlear implantation. After reviewing the evidence submitted as part of the National Coverage Determination (NCD) process, CMS found that the evidence was sufficient to determine that cochlear implantation may be covered for a broader spectrum of hearing loss. The policy change is effective immediately.

Specifically, CI is an appropriate treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition. Patients must meet other criteria defined by CMS as well. The final decision memorandum for the reconsideration of Cochlear Implantation was published here:  https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=306

The change was sought early on by the newly organized American Cochlear Implant Alliance with a multi-center study to explore and document outcomes in older adults who had more residual hearing than was currently allowed under Medicare coverage criteria. We approached the Centers for Medicare and Medicaid Services (CMS), requesting that they partner with us and allow Medicare expanded coverage for individuals who were part of the ACI Alliance study. Principal investigators Terry Zwolan PhD, Craig Buchman MD, and John Niparko MD led the multi-center study effort. Their thoughtful leadership over a sustained timeframe led to this important outcome. Click here  for more information on the expansion effort.

Drs. Zwolan and Buchman expressed gratitude to the CI clinicians and patients who participated in the study effort as well as CMS officials involved in the NCD process as they sought to balance care in provision of the CI intervention for older adults with the documented outcomes in communication and overall quality of life.

We will be providing materials for our ACI Alliance members who wish to help publicize this important expansion in access to CI with local media outlets, patients, and others. 

READ MORE