Medicare Keeps the Audiology Osseointegrated Implant as Benefit
Successful advocacy efforts from ASHA and other audiology stakeholders resulted in a significant win for the audiology community. In July, the Centers for Medicare and Medicaid Services (CMS) determined to reclassify osseointegrated implants as “hearing aids” and effectively disqualified the prosthetic devices from Medicare coverage. CMS released the final Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) rule for 2015, and note that they were changing their position due to the requests of several commenters for reconsideration.
Subsequently, CMS has finalized the following:
(1) Scope. The scope of the hearing aid exclusion encompasses all types of air conduction hearing aids that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound and bone conduction hearing aids that provide mechanical stimulation of the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles.
(2) Devices not subject to the hearing aid exclusion. Paragraph (d)(1) of this section shall not apply to the following devices that produce the perception of sound by replacing the function of the middle ear, cochlea, or auditory nerve:
(i) Osseointegrated implants in the skull bone that provide mechanical energy to the cochlea via a mechanical transducer, or
(ii) Cochlear implants and auditory brainstem implants that replace the function of cochlear structures or auditory nerve and provide electrical energy to auditory nerve fibers and other neural tissue via implanted electrode arrays. 42 CFR §411.15
The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) rule is proposed annually to update fee schedules and special payment rules. When the proposal to change the definition of prosthetics and hearing aids was noted, ASHA and other stakeholders coordinated efforts to meet with CMS and submit formal comments. ASHA recommended no change to the current definition, and to include “non-osseointegrated” into the definition of hearing aid. Additionally, ASHA recommended that CMS convene a Technical Expert Panel of audiologists and otolaryngologists to discuss and determine technology appropriate for Medicare coverage. Currently, Medicare does not cover hearing aids under the regular Medicare benefit.
For more information, please contact Lisa Satterfield, ASHA’s director of health care regulatory advocacy, at email@example.com.
Lemmietta G. McNeilly, PhD, CCC-SLP, CAE, ASHA Fellow
Chief Staff Officer, Speech-Language Pathology
American Speech-Language-Hearing Association
2200 Research Boulevard, #229
Rockville, MD 20850-3289
+1 301-296-5705 telephone