Medicare Compliance & Reimbursement

Facilities must check the tests.

Facilities that perform cochlear implantation for certain patients can get the Centers for Medicare and Medicaid Services to help foot the bill - if the physician performed the implantation after April 4, 2005.

For a facility to receive reimbursement, its patients must fall into one of these two categories, according to a July 1 revision from CMS:

 People with moderate-to-profound hearing loss who score at or less than 40 percent correct on a hearing test on the best aided listening condition. The test must be tape-recorded tests of open-set sentence recognition, and the patient must show benefit from amplification.

 People whose scores on the same kind of test are greater than 40 percent and up to 60 percent, and who received the implantation during a clinical trial. The patient needs to have received the device at one of these trials, according to Medicare: an FDA-approved category-B investigational device exemption clinical trial, a trial under the CMS Clinical Trial Policy, or a prospective, controlled, comparative trial approved by CMS.