Billing and Coding: External Components for Cochlear Implants

A cochlear implant system consists of both internal (implanted) and external components. The external components consist of a microphone, sound processor and a transmitter. Replacement of cochlear implant components not otherwise covered under a manufacturer's warranty: There are very few mechanical problems associated with cochlear implants, and replacement of existing components due to device failure occurs infrequently. However, there have been many revisions and upgrades to the various components leading to improvements in design and speech perception. Replacement of an existing, functioning cochlear implant component is covered only when a physician certifies that: The existing component is ineffective to the point of interfering with the activities of daily living, or When there is a change in the patient's medical condition necessitating a different type of component, or The existing component has reached its reasonable useful life. The reasonable useful life of a sound processor is not less than 5 years. Replacement or upgrades of existing, functioning cochlear implants or cochlear implant components for any reason before the component has reached its reasonable useful life are not covered by Palmetto GBA. For example, upgrading to next generation, smaller profile external components, or switching from a body worn sound processor to a behind-the-ear model is considered a convenience. Supplies or accessories that are not necessary for the functioning of the cochlear implant, such as cell phone adapters, telecoils, carrying cases, keychain wallets, or car charger adapters, and accessories and upgrades to accommodate personal convenience or deluxe items are not covered by Palmetto GBA. Accessories and supplies should be reported with HCPCS code L9900. When replacing headset/headpiece, microphone, transmitting coil or transmitter cable for use with cochlear implant device, the correct HCPCS code should be used instead of L7510. When a repair is being done on a prosthetic device, the labor component is billed with HCPCS code L7520. Each billable unit represents 15 minutes of labor time. Documentation should include the original purchase date of the item “repaired”, the reason for “repair”, the item “repaired”, the functionality of the item “repaired” and the invoice cost from the manufacturer. The specific items “repaired” should be documented with invoice cost and the specific parts “repaired”. Repairs and replacement of “minor” parts and pieces can be billed under code L7510. Replacement items can be billed under L7510 if no other code is suitable. DO NOT BILL ACCESSORIES under code L7510. Labor cost does not apply when items are being replaced. Battery Quantity Limit Per Implant HCPCS Code Per Month Per 3 Months Other L8621 30 90 N/A L8622 60 180 N/A L8623 N/A N/A 4 per 12 months L8624 N/A N/A 4 per 36 months For any exceptions please submit the appropriate narrative in item #19 claim field of the electronic 5010 form or on an attachment for paper claims. Following is an example of items classified as convenience and not necessary for the functionality of the Cochlear Implant device and are considered an accessory to be billed under code L9900: Attachment/Connection/Safety Clips Audio Interface Device Car Adapters Cable Adapters Ear Hook Pins DaCapo Extension Kits Drying supplies - Manual/Electrical Fine Tuner/Fine Tuner Batteries Fixation Bar Mini Battery Packs Microphone Tester Device Kit Device Protectors Remote Battery Packs Repair Kits Telephone Adapter T Mic Microphone Following is an example of items that are considered a major part of the device and should be billed under the specific L code listed in the CPT/HCPCS Code table provided below: Batteries Cables Coils Controllers Headsets Microphones Processors The following items are considered a major part of the device and would be replaced every three years for reasonable use: Battery Chargers Battery Packs Ear Hook Microphone cover Note: When billing the items listed above include the original purchase date of the device, the last replacement date of the item billed and the reason for replacement.