Does S2235 require prior authorization?

No, S2235 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S2235?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Cochlear implantation is considered medically necessary whenbothcriterion 1andcriterion 2 listed below are met:The individual meetsAllthe following criteria (a through c):Has received limited benefit from conventional hearing aids;andIs able to participate* in a post-cochlear implant rehabilitation program;andAbsence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorde [...]
The individual meetsAllthe following criteria (a through c):Has received limited benefit from conventional hearing aids;andIs able to participate* in a post-cochlear implant rehabilitation program;andAbsence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorders.*Note: For a young child, a parent or guardian may act as the surrogate for participation.and
Has received limited benefit from conventional hearing aids;and
Is able to participate* in a post-cochlear implant rehabilitation program;and
Absence of any of the following (i through iv):Active middle ear infections;orLesions in the auditory nerve; orLesions in the central auditory pathway;orAuditory neuropathy spectrum disorders.*Note: For a young child, a parent or guardian may act as the surrogate for participation.and

ANTHEM-CG-SURG-81, Cochlear Implants and Auditory Brainstem Implants

BCBSIL-SUR714.009, Auditory Brainstem Implant

BCBSMT-SUR714.009, Auditory Brainstem Implant

BCBSNM-SUR714.009, Auditory Brainstem Implant

BCBSOK-SUR714.009, Auditory Brainstem Implant