Coverage with Evidence Development

Cochlear Implantation

The NCD for Cochlear Implantation (50.3), released by CMS in April 2005, concluded that,  effective for services performed on or after April 4, 2005, cochlear implantation may be covered for individuals meeting certain  selection guidelines (see below)  and with hearing test scores of greater than 40% and less than or equal to 60% only when the provider is participating in, and patients are enrolled in, either an FDA-approved category B investigational device exemption clinical trial as defined at 42 CFR 405.201, a trial under the Centers for Medicare & Medicaid (CMS) Clinical Trial Policy as defined at section 310.1 of the National Coverage Determinations Manual, or a prospective, controlled comparative trial approved by CMS as consistent with the evidentiary requirements for National Coverage Analyses and meeting specific quality standards.

Patient eligibility criteria for any of the above study types include individuals who meet all of these five selection criteria:

  1. Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
  2. Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
  3. Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
  4. No contraindications to surgery; and
  5. The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling.

Potentially, the results of trials may provide sufficient evidence of clinical utility that a future NCD on this topic will provide for the expansion of the current coverage of cochlear implantation.

As of this date, no studies have been approved within the authority above.

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