Cochlear implants (new) - coverage for clients age 21 and older, effective 1/1/2024

Washington State Health Care Authority sent this bulletin at 12/26/2023 03:30 PM PST

December 26, 2023

Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

Effective for dates of service on and after January 1, 2024, the Health Care Authority (HCA) will begin covering new cochlear implants (CPT® code 69930) for eligible clients, ages 21 and older, with bilateral severe to profound hearing loss. Prior authorization is required.

HCA is updating the Physicians Related Services/Health Care Professional Services Billing Guide with this change, including specific billing details and authorization requirements.

Watch for the January 1, 2024, edition to be posted online. HCA is currently revising several Apple Health provider billing guides for January 1, 2024, and will upload them as they are completed. You can find HCA’s provider billing guides on HCA’s Pr ovider billing guides and fee schedules webpage.

(Current Procedural Terminology (CPT)
copyright 2023 American Medical Association (AMA).
All rights reserved. CPT is a registered trademark of the AMA.)

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.