MedicaidCoverageMedium impact
Cochlear Implant - MEDICAID - LOUISIANA (New)
Humana·LA · ENT (Ear, Nose & Throat), Audiology, Speech Therapy +1 more·Medicaid
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its Louisiana Medicaid cochlear implant coverage policy (effective 01/01/2023, reviewed 10/01/2024). The policy covers unilateral or bilateral cochlear implants for members under 21 years of age with severe-to-profound bilateral sensorineural hearing loss, requiring a multidisciplinary team evaluation (pediatric otolaryngologist/otologist, audiologist, speech-language pathologist) and comprehensive pre- and post-operative assessments. No substantive coverage changes occurred in the 9/26/2024 review—only minor grammatical updates and reference refreshes.
Action Required
By 10/31/2024 (or upon first claim submission after policy review): (1) Billing team must ensure prior authorization workflows include verification that all multidisciplinary team requirements are documented before claim submission for cochlear implant procedures. (2) Update billing system templates to flag cochlear implant claims for members under 21 with severe-to-profound hearing loss for mandatory prior authorization review per policy section 1.1. (3) Providers submitting cochlear implant claims must include documentation of: audiological evaluation, medical history/physical exam, immunization verification, imaging studies (CT/MRI), auditory nerve integrity testing where applicable, speech/language evaluation, and psychological/social evaluation. (4) For bilateral implant claims, documentation must demonstrate that unilateral implant plus hearing aid will not provide binaural benefit. (5) Front desk and billing staff should verify member age eligibility (under 21) at initial claim intake. Failure to obtain prior authorization or submit required documentation will result in claim denials or rework.