Cochlear Implants and Related Services
Effective for dates of service on or after Jan. 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is updating the audiological services benefit by extending coverage for cochlear implants and related services to full-benefit Healthy Connections Medicaid members age 21 years and older. Cochlear implants and related services are already a covered benefit for full-benefit Healthy Connections Medicaid members under 21 years of age.
Benefit Criteria and Limitations
Members age 21 years and older with unilateral or bilateral severe to profound sensorineural hearing loss will be covered to receive placement, replacement and maintenance of cochlear implants that have prior authorization and are delivered in accordance with the clinical standards of medical and audiological practices. This change will be added to the Private Rehabilitative Therapy Audiological Services provider manual by Jan. 1, 2024.
Providers must file prior authorization requests with SCDHHS’ quality improvement organization (QIO) for cochlear implants and related services through one of the following ways:
- Calling customer service at (855) 326-5219;
- Faxing to (855) 300-0082; or · Emailing atrezzoissues@Kepro.com
South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at: http://www.scdhhs.gov/contact-us.
Resources Providers Can Use to Help with Medicaid Member Annual Reviews
As SCDHHS continues its federally required review of Medicaid member eligibility, a process frequently referred to as “unwinding,” it is reminding providers of resources available to them that can help with this process. SCDHHS has produced several member-facing communications and marketing items and is encouraging providers to post its “submit your review, when it’s time to renew” flyer in patient-facing areas. The flyer is available for download from SCDHHS’ website in English and in Spanish along with other provider resources on SCDHHS’ annual reviews website.
The Centers for Medicare and Medicaid Services have also produced outreach and educational resources about this process that are available on their website.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.