Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2018

Cochlear Implants to Require Prior Authorization


Effective for dates of service beginning June 1, 2018, Harvard Pilgrim will require prior authorization for cochlear implants for members in our commercial HMO, POS, and PPO products. Harvard Pilgrim will provide coverage for unilateral or bilateral cochlear implants for adults and children and hybrid implants for adults who meet the medical review criteria.

The following codes will require prior authorization as of June 1, 2018: 

  • 69930 — Cochlear device implantation, with or without mastoidectomy
  • 92601 — Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with programming
  • 92602 — Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming
  • 92603 — Diagnostic analysis of cochlear implant, age 7 years or older, with programming
  • 92604 — Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming
  • L8614 — Cochlear device/system, includes all internal and external components
  • L8615 — Headset/headpiece for use with cochlear implant device, replacement
  • L8616 — Microphone for use with cochlear implant device, replacement
  • L8619 — Cochlear implant external speech processor, replacement
  • L8628 — Cochlear implant, external controller component, replacement

Please refer to the updated Cochlear Implants Medical Review Criteria for the full criteria and details on documentation necessary to obtain prior authorization. To request prior authorization, please complete the Cochlear Implants Prior Authorization Request Form and fax it to 800-232-0816.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Reminder: Medical Drugs & Buy-and-Bill or Specialty Pharmacy

CLINICIAN CORNER

Cochlear Implants to Require Prior Authorization

Update to Bariatric Surgeries Prior Authorization Policy

New Bunionectomy Medical Review Criteria

Harvard Pilgrim Adding Coverage for Newly Approved Medications

Tips for Efficient Pharmacy Prior Authorization Process

Complex Case Management Services

Disease Management Programs Reinforce Physician Treatment Plans

Updates to Medical Policies and Prior Authorization Criteria

Policy Update: Replacement of the First Metatarsophalangeal Joint

Updates to Implantable Neurostimulators Medical Review Criteria

Corneal Collagen Cross-Linking Now Covered

New Prior Authorization Policy for Hemlibra

New Prior Authorization Policy for Imfinzi

Substance Use Disorder: Treatment and Helpful Resources

P&T Committee Meeting Update

OFFICE ASSISTANT

Payment Policy Updates: DME and Orthotic and Prosthetic Devices

Medical Records: Common Issues and Quick Fixes

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator