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  Indiana Medicaid

email: reimburse@cochlear.org




Indiana Medicaid covers cochlear implant services for both adults and children. This includes coverage for replacement parts. Replacements of all but batteries requires prior authorization.

Medicaid payment rates in Indiana are far below Medicare, and force hospitals to incur losses of nearly $8,000 on outpatient surgeries, just on the acquisition of the device, and over double that amount on inpatient surgeries. Thus, is is not surprising that Riley Hospital, Methodist Hospital, and Saint Vincent's Hospital are currently the only hospitals in Indiana performing cochlear implants.

As of January 1, 2005, Indiana Medicaid reimburses for outpatient cochlear implant services as follows:

CPT 69930 (physician professonional fee) $1,171

HCPCS L8614 (CI device system) $14,082

HCPCS L8619 (replacement speech processor) $6,045

CPT 92601 (CI follow-up exam under age 7) $91.51

CPT 92602 (processor programming under age 7) $64.06

CPT 92603 (CI follow-up exam age 7 or more) $61.47

CPT 92604 (processor programming age 7 or more) $41.80

Indiana Medicaid reimburses inpatient cochlear implant surgeries under their "Level of Care" methodology, which reimburses a flat fee for several broad areas of care. Consequently, cochlear implant inpatient surgeries are paid roughly only $4,500 under local Diagnosis Related Group (DRG) 759. Medicaid argues that hospitals should be able to make up any losses on cochlear implants from other services which costs less than $4,500.