Effective 06/30/26: Criteria Change for Cochlear Replacement and Repair Requests
Date: 05/29/26
Beginning on June 30, 2026, Superior HealthPlan will utilize Change Healthcare’s InterQual as the medical necessity review criteria of Cochlear replacements and device repairs for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter Health (Ambetter from Superior HealthPlan and Ambetter Health Solutions) members.
Superior HealthPlan ensures medical necessity review criteria are current and appropriate for members and the scope of services provided.
Applicable Products: Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Ambetter Health
Procedure Code | Description | Criteria |
L8615 | Headset/headpiece for use with cochlear implant device, replacement |
Change Healthcare’s InterQual criteria, proprietary, but available upon request for Cochlear Replacement and Repairs. |
L8616 | Microphone for use with cochlear implant device, replacement | |
L8617 | Transmitting coil for use with cochlear implant device, replacement | |
L8618
| Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement | |
L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement | |
L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each | |
L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each | |
L8614 | L8614 Cochlear device, includes all internal and external components | |
L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each | |
L8624 | Lithium ion battery for use with cochlear implant device speech processor, ear level replacement, each | |
L8627 | Cochlear implant, external speech processor, component, replacement | |
L8628 | Cochlear implant, external controller component, replacement | |
L8629
| Transmitting coil and cable, integrated, for use with cochlear implant device, replacement |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.