Paying for upgrades
Learn about insurance eligibility, self-paying and options to cover out-of-pocket costs.
What you'll find on this page
- Learn about insurance eligibility
- Self-paying
- Options to cover out-of-pocket costs
We can help you navigate the insurance system
Nucleus® 7 and Kanso® 2 Sound Processors
The average cost of a cochlear implant sound processor upgrade is $1,800-$3,000, depending on your health plan.
Baha® 6 Max Sound Processor
The average cost of a Baha sound processor upgrade is $750-$1,000, depending on your health plan.
At Cochlear, we are here to help you along your entire hearing journey — including making sure you understand your insurance coverage and the various payment options available. Our Reimbursement and Insurance Services team will work directly with your insurance provider so you can avoid the hassle and focus on enhancing your hearing experience. We also have options if you choose to self-pay for your new sound processor. Below, explore payment options for your Cochlear sound processor upgrade.
Three ways to pay for a sound processor
If you are uninsured or insured but do not have an insurance benefit available and would like to access the latest Nucleus technology now, you can take advantage of the discounted self-pay price of $6,775 USD when you trade-in a non-retired sound processor.2 If you choose to keep your existing processor, the self-pay cost is $9,775 USD.3,4
You can access the latest in Baha technology for the discounted self-pay price of $3,600 USD when you trade-in a non-retired processor.2 If you keep your existing processor, the self-pay cost is $4,600 USD.3,4
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Self-paying allows you to access the latest technology sooner, but may cost you a bit more
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If you do not have health insurance coverage or you have a benefit exclusion on your plan, self-paying may be the best option
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If you are not yet eligible to upgrade through your insurance, you may choose to wait until you become eligible in order to take advantage of your benefits. The eligibility for upgrades varies based on your insurance plan. Contact us to learn about eligibility for your specific insurance plan.
Your upgrade may qualify for reimbursement for the purchase under your insurer’s "replacement sound processor" benefit.
- Call the Member Service phone number listed on the back of your insurance ID card and provide HCPCS (Healthcare Common Procedure Coding System) code L8619 for Nucleus 7 and Kanso 2 and codes L8691 and L8694 for Baha 6. Refer to the upgrade as a "replacement sound processor." Before you finalize the order, be sure to confirm your insurer's required procedures. If a pre-authorization step is available, inquire the steps. Also, request an in-network exception.
- Once you have the proper form(s) signed, complete your order form and send it, along with your preferred phone number or email address, to recipient@cochlear.com.
- Download a Pre-Authorization/In-Network Request Sample Letter.
- Follow your insurance plan's procedures for seeking reimbursement on your upgrade order.
This option applies if you have Medicare, Medicaid, or private health insurance or a combination of those coverages. Our reimbursement specialists can assist you in accessing your benefits and support you through the process.1
What are the benefits of using Cochlear Reimbursement and Insurance Services?
- Experts to help guide you through the process
- We understand navigating insurance may feel overwhelming. Our experts will guide you through every step of the process, keep you updated on your order status and answer any questions you may have.
- Don’t have to deal with the insurance company on your own
- When utilizing our Reimbursement and Insurance Services, we work directly with your insurance so you don’t have to. Our experts can navigate the insurance details and streamline the process to make it easier for you.
Direct insurance billing for a Cochlear sound processor upgrade
The insurance process can be confusing and difficult to navigate, which is why Cochlear provides direct insurance billing on your behalf when you are insured by private insurance, Medicare, many state Medicaid plans (including HMOs), and TRICARE. The Cochlear Reimbursement and Insurance Services team navigates the insurance process for you by seeking prior authorization from these plans.1 We will verify your insurance benefits, gather supporting documentation to determine medical necessity from your clinician and determine your estimated out-of-pocket costs. We continue to monitor the process and keep you informed until you have received your new sound processor.
Frequently Asked Questions
The cost of an upgraded sound processor varies based on if you choose to self-pay or use your insurance. Insurance plans vary widely. To understand your specific out-of-pocket cost, please contact Cochlear or schedule an appointment with a Customer Relationship Specialist.
Insurance typically covers a portion of an upgraded sound processor. However, plans vary widely. Contact Cochlear or schedule an appointment with a Customer Relationship Specialist to determine your insurance coverage and understand you out-of-pocket costs.
Cochlear provides direct insurance billing on your behalf when you are insured by private insurance, Medicare (including HMOs) , many state Medicaid plans (including HMOs), and TRICARE. The Cochlear Reimbursement and Insurance Services team navigates the insurance process for you, including helping with approvals and paperwork, so you can avoid the hassle of the insurance process.1
Upgrading your Cochlear Sound Processor is an exciting, rewarding and personal choice that deserves a unique and personalized journey. We are here to help you confidently select the best option for you. Contact us at 1-800-790-8737 to get started today.
More information
Disclaimer
- Information provided by Cochlear Americas regarding insurance coverage or reimbursement is provided as guidance only and is not intended as reimbursement or legal advice. Cochlear Americas makes no representation or warranty regarding such information or its completeness, accuracy, fitness for a particular purpose, or that following such guidance will result in any form of coverage or reimbursement from any insurer. Information presented is subject to change at any time. To be sure that you have the most current and applicable information available for your unique circumstances, please consult your own experts and seek your own legal advice regarding your reimbursement needs. In all cases, products or services billed must be medically necessary, actually performed and appropriately documented in the medical record. Coverage determinations and out-of-pocket costs may vary for individuals with private insurance.
- You may trade-in one (1) non-obsolete Nucleus Sound Processor when you choose to self-pay. This offer excludes upgrade orders placed through Reimbursement & Insurance Services. Limit 1 trade-in per order.
- This price does not apply when placing an upgrade order through Cochlear’s Reimbursement & Insurance Services. The Reimbursement & Insurance Service is a Premium Service. Upgrade will be billed to your insurance at the existing list price for the upgrade. Coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage. Please make your selections on colors, sizes, and other options prior to placing your upgrade order. Pricing subject to change at any time. The following states require that sales tax be charged on upgrade orders: Alabama, South Carolina, Illinois, and Delaware. Note: This price does not include any additional fees that may be incurred during the programming of the processor with your hearing healthcare provider. Products can be returned or exchanged within 90 days of your upgrade shipment date at no charge.
- Please keep in mind, if you choose to self-pay today, you may not be able to submit a claim to your insurance on your own if Cochlear is contracted with your private insurance provider. Visit www.cochlear.com/us/insurancelist to see if Cochlear is contracted with your insurance provider. If Cochlear is contracted with your insurance provider, we suggest placing your order through Cochlear’s Reimbursement & Insurance Services.
The Nucleus 7 Sound Processor is compatible with the Nucleus Profile Plus, Nucleus Profile Series, CI500 Series, CI24RE (Freedom) Series, CI24R, CI24M and CI22M implants.
The Kanso 2 Sound Processor is compatible with the Nucleus Profile Plus, Nucleus Profile Series, CI500 Series, CI24RE (Freedom) Series, CI24R and CI24M implants. The Kanso 2 Sound Processor will not be compatible with the Nucleus® 22 (N22) Implant due to the Kanso 2 Sound Processor's size and coil type.
Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, DC, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MS, MT, NC, NE, NJ, NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY. The Reimbursement and Insurance Services is a Premium Service. Billable pricing, coverage and out-of-pocket expenses will vary depending on your insurance benefit coverage.
Please seek advice from your medical practitioner or health professional about treatments for hearing loss. They will be able to advise on a suitable solution for the hearing loss condition. All products should be used only as directed by your medical practitioner or health professional. Not all products are available in all countries. Please contact your local Cochlear representative.
Views expressed by Cochlear recipients and hearing health providers are those of the individual. Consult your hearing health provider to determine if you are a candidate for Cochlear technology. Outcomes and results may vary.
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