Navigating insurance can feel overwhelming. This Insurance Support Center provides a wealth of information to help you understand the insurance reimbursement process.
As of Feb 1, 2018, Cochlear provides direct insurance billing support for many major private insurance plans, Medicare, Medicaid* (including HMOs) and Tricare for repairs, parts and accessories. Cochlear’s full-service billing support is available for recipients who are covered under one of the plans with whom Cochlear is contracted. If you would like to place an order for a replacement part or accessory, please keep in mind orders may take up to 2 weeks to process and ship, so please plan ahead.
Please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim 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 and Insurance Services. If you seek reimbursement on your own you will be solely responsible for any amounts to include contractual or discounted payments that your insurance provider does not cover.1, 2
*Cochlear is currently enrolled with Medicaid programs in the following states: AZ, CA, CO, CT, DC, FL, GA, IA, ID, IL, IN, KS, KY, LA, ME, MI, MN, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY.
Health plans have their own definitions of what is considered Medically Necessary, but typically includes anything that improves your hearing, or is required for the device to function, such as cables, coils, magnets, and rechargeable batteries.
Here is a list of HCPCS codes commonly used for Cochlear’s products (NOTE: please check with your insurance provider or with Cochlear periodically as these codes are subject to change).
HCPCS Codes | Description | |
Repair | L7510 | Repair of prosthetic device, repair or replace minor parts |
L7520 | Repair of prosthetic device, labor component, per 15 minutes | |
L8617 | Transmitting coil for use with cochlear implant device, replacement | |
Replacement Parts and Accessories | L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement |
L9900 or State Misc. Code | Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS "l" code | |
L8617 | Transmitting coil for use with cochlear implant device, replacement | |
L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement (used for Nucleus 7) | |
Rechargeable Batteries | L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each |
Battery Charger | L8625 | External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each |
CI Sound Processor Replacement | L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement |
Baha Sound Processor Replacement | L8691 and L8694 or State Misc. Code | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each |
Baha Transducer/Actuator | L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each |
Baha System Without Osseo | L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment; initial purchase must be placed through a clinic |
You can place an order 24 hours a day, 7 days a week on the online store. Or, you can call 866-477-0906 to place your order.
Click on the tabs below to review each step:
Log in to your Cochlear Family account. If you do not already
have an account, you will need to register for one. Click here to activate your
Cochlear Family account. You can access the online
Cochlear Store from your Cochlear Family account. Keep in mind,
items in the Cochlear Store, marked with this icon are
generally covered by insurance. For these items, you will need
to check the box for ‘Bill my insurance’ if you would like
Cochlear to bill your insurance for the selected product. Once
your shopping cart is full, complete your purchase by following
the steps as prompted.
If this is your first time purchasing products or services from Cochlear or your insurance information has changed, you will need to complete the Insurance Intake Form.
As a Durable Medical Equipment (DME) provider, Cochlear will request a physician’s order and/or a signed Letter of Medical Necessity (LMN) from your clinician on your behalf. This serves as a prescription that allows Cochlear to provide the products ordered to you and justifies they are medically necessary for your cochlear implant to continuously function.
Cochlear will work to verify your insurance benefits, gather supporting documentation from your clinician, and for replacement sound processor orders will determine your estimated out-of-pocket costs. Your order will ship after these steps have been completed. Parts and Accessories typically take 2 weeks from the date your order is placed where processors take up to 6-8 weeks. After shipment, Cochlear will submit claims and receive payment from your insurance. You will be responsible for paying any applicable coinsurance, deductible, or amounts not covered by your insurance to Cochlear.
If you have an urgent need and cannot wait for the insurance approval process you may want to consider self-pay to expedite shipping. Please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim 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 and Insurance Services. If you seek reimbursement on your own you will be solely responsible for any amounts to include contractual or discounted payments that your insurance provider does not cover.
Once all documentation is received, Cochlear will process your order. You can track your order status by logging into your Cochlear Family account at www.Cochlear.com/US/Family and clicking on “Manage” and then “Orders.” You will also receive status emails throughout the process to keep you updated as your order progresses. Cochlear will email you a shipment confirmation with shipment tracking details. Cochlear ships most of its orders using standard two to three day delivery with a signature required upon delivery. Please note - if Cochlear is billing your insurance for a part or accessory order, we will collect any remaining coinsurance from you after your order ships.
Seeking insurance reimbursement on your own is a 5 step process.
Click on the tabs below to review each step:
Please keep in mind that if you choose to self-pay for an item generally covered by insurance, you may not be able to submit a claim on your own if Cochlear is contracted with your private insurance provider. Check our Insurance Plans page 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 and Insurance Services. If you seek reimbursement on your own you will be solely responsible for any amounts to include contractual or discounted payments that your insurance provider does not cover.
Call the Member Services phone number on the back of your insurance identification card. If you’re calling for a sound processor replacement, provide the HCPCS to your insurance provider and refer to it only as a “replacement sound processor.” TIP: Replacement sound processors (i.e. sound processor replacements) to newer technology are covered under the Durable Medical Equipment (DME) benefit section of your health plan. If you do not have DME benefits, ask your insurance provider if they will consider covering the billing code under your major medical benefits.
Once your order has shipped, follow your insurance plan's guidelines for reimbursement. The requirements may vary depending on the coverage, but the basic steps are outlined below.
The process to file a claim typically includes the following steps:
Click on the tabs below to review each step of the process:
1. 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.
2. Coverage determinations and out-of-pocket costs may vary for individuals with private
insurance.
*Cochlear is pleased to offer this discounted cash price when self-paying directly with Cochlear.
This discount does not apply when placing an upgrade order through Cochlear's Reimbursement &
Insurance Services. Insurance coverage and out-of-pocket expenses will vary depending on your
insurance benefit coverage.
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.
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