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August 15, 2005

Briefing Moments
By Barbara Bosler, MS, RHIA
For The Record
Vol. 17 No. 17 P. 10

Cochlear Implants
Cochlear implants are surgically implanted devices used to stimulate auditory nerve fibers in individuals who are moderately to profoundly hearing impaired. Part of the device is worn or carried by individuals to capture, analyze, and code sound. Medicare has expanded its coverage for individuals with hearing test scores equal to or less than 40% correct in the best-aided listening condition on tape-recorded tests of open-sentence recognition and who demonstrate limited benefit from amplification. Coverage will be determined from patients meeting all of the following selection guidelines:

• diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;

• cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;

• freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and lesions in the auditory nerve and acoustic areas of the central nervous system; and

• no contraindications to surgery.

Coverage will also include individuals with open-set sentence recognition test scores of greater than 40% to less than or equal to 60% correct where the device was implanted in an acceptable trial.

Common Healthcare Common Procedure Coding System (HCPCS) codes used for billing cochlear implantation services and devices provided by audiologists or physicians, and for the services provided by speech language pathologists are:

• 69930 — Cochlear device implantation, with or without mastoidectomy;

• L8614 — Cochlear device/system;

• L8619 — Cochlear implant external speech processor, replacement;

• L7500 — Repair of prosthetic device, hourly rate (excludes V5335 repair of oral laryngeal prosthesis or artificial larynx);

• L7510 — Repair of prosthetic device, repair or replace minor parts;

• 92506 — Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status;

• 92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation), individual; and

• 92601 — Diagnostic analysis of cochlear implant, patient under the age of 7, with programming.

The expanded coverage is effective for services provided on or after April 4. See CMS Transmittals 601 and 42 for complete billing instructions regarding the expanded coverage. A complete list of audiology codes can be found in Pub 100-4, chapter 12, section 30.3.

Coverage of Aprepitant for Chemotherapy-Induced Emesis
The Centers for Medicare & Medicaid Services (CMS) is extending national coverage for the use of the oral antiemetic, three-drug combination of aprepitant (Emend), a 5-HT3 antagonist, and dexamethasone for patients receiving one or more of the following anticancer chemotherapeutic agents:

• carmustine;

• cisplatin;

• cyclophosphamide;

• dacarbazine;

• mechlorethamine;

• streptozocin;

• doxorubicin;

• epirubicin; and

• lomustine.

Aprepitant is the first FDA-approved drug of its type to work in combination with other oral antiemetics for patients receiving highly emetogenic chemotherapy. The purpose of this three-drug combination is to better control the severity of chemotherapy-induced nausea and vomiting (CINV) that is influenced by the chemotherapeutic agent(s) used and dosage, schedule, and route of administration. Personal risk factors for CINV severity include sex, age, history of motion sickness, and prior exposure to chemotherapeutic agents.

The coverage applies to services provided on or after April 2. See CMS Transmittals 590 and 40 for more information.

Osteogenic Stimulators
The CMS determined that noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to surgical intervention is reasonable and necessary. The CMS expects the following to diagnose nonunion bone fractures:

• A minimum of two sets of radiographs obtained prior to starting treatment with the osteogenic stimulator. At least 90 days must pass between radiograph sets one and two.

• Each radiograph set must include multiple views of the fracture site accompanied with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the two sets of radiographs.

Nonunion fractures of the skull and vertebrae, and those that are tumor-related, are excluded from coverage. See CMS Transmittals 597 and 41 for complete information.

— Barbara Bosler, MS, RHIA, is a Michigan-based consultant in business practice healthcare functions.

Reference
Centers for Medicare & Medicaid Services 2005 Program Transmittals / Program Memos. Centers for Medicare & Medicaid Services Web site. Available at: http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

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