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(1) The agency covers, with prior authorization, cochlear devices for clients twenty years of age and younger with the following limitations:
(a) The client meets one of the following:
(i) Has a diagnosis of profound to severe bilateral, sensorineural hearing loss;
(ii) Has stimulable auditory nerves but has limited benefit from appropriately fitted hearing aids (e.g., fail to meet age-appropriate auditory milestones in the best-aided condition for young children, or score of less than ten or equal to forty percent correct in the best-aided condition on recorded open-set sentence recognition tests);
(iii) Has the cognitive ability to use auditory clues;
(iv) Is willing to undergo an extensive rehabilitation program;
(v) Has an accessible cochlear lumen that is structurally suitable for cochlear implantation;
(vi) Does not have lesions in the auditory nerve and/or acoustic areas of the central nervous system; or
(vii) Has no other contraindications to surgery; and
(b) The procedure is performed in an inpatient hospital setting or outpatient hospital setting.
(2) The agency covers BAHAs for clients twenty years of age and younger with prior authorization.
(3) The agency covers replacement parts and batteries for BAHAs and cochlear devices for clients twenty years of age and younger only. See WAC 182-547-0800
(4) The agency considers requests for removal or repair of previously implanted BAHAs and cochlear devices for clients twenty one years of age and older only when medically necessary. Prior authorization from the agency is required.
(5) For audiology, the agency limits:
(a) Caloric vestibular testing to four units for each ear; and
(b) Sinusoidal vertical axis rotational testing to three units for each direction.
[Statutory Authority: RCW 41.05.021
. WSR 15-03-042, § 182-531-0375, filed 1/12/15, effective 2/12/15. WSR 11-14-075, recodified as § 182-531-0375, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 11-14-055, § 388-531-0375, filed 6/29/11, effective 7/30/11.]