Prior Authorization

Cochlear Implant

A cochlear implant requires prior authorization. Authorization is based on written documentation submitted to the department by the physician that confirms the following:

1. The implant will provide an awareness and identification of sound and will facilitate communication;
   
   
2. There is a diagnosis of sensorineural hearing loss that is not clinically improved by the use of a hearing aid;
   
   
3. The individual has a cochlea that will accept an implant;
   
   
4. There are no lesions of the individual's auditory nerve or acoustic areas of the central nervous system; and
   
   
5. The individual demonstrates the cognitive ability to use auditory clues and there is a willingness to undergo an extended program of rehabilitation.
   

Services, supplies, and implant systems are not covered if the request is to replace or upgrade a device that is functioning appropriately.


Documentation Requirements:

• Prior Authorization Request Form

Submit your completed form to:

• Department of Social Services
  Division of Medical Services
  Nurse Consultant
  510 N Cambell
  PO Box 2040
  Rapid City, SD 57709-2440
  
• Phone 605-394-1740
  
• Fax: 605-394-2699