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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:

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