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What is a Cochlear Implant?
A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. An implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. An implant has the following parts:
- A microphone, which picks up sound from the environment
- A speech processor, which selects and arranges sounds picked up by the microphone
- A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses
- An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve
An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech. A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds, so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants or other cochlear devices. Below are the DHMP benefits by line of business (LOB) for cochlear implants, including the entity that is responsible for review and management of services.
Cochlear Implant Benefits by Line of Business
Managed by State of Colorado
Cochlear Implants are a WRAP Benefit for Medicaid members. Benefits are administered exclusively by the State for review and subsequent approval or denial. DHMP has no authority over any Wrap Benefit and therefore DHMP Utilization Management cannot issue an approval or denial. Submit prior authorization requests to the State of Colorado. Refer to the Fee schedule for coverage and pricing.
Managed by DHMP
Cochlear implants or other cochlear devices are a covered benefit with prior authorization, upon determination of medical necessity. Inpatient and outpatient charges apply. Member handbooks provide additional details and can be found on each plan member page, under the 'Members' tab of this website.
Services Requiring Prior Authorization
Prior Authorization Request Form