Guest guest Posted November 28, 2006 Report Share Posted November 28, 2006 Hi : It sounds like your company just wants to purchase a less expensive health plan for its employees because it is not true that most health plans exclude the cochlear implant. In fact, it is quite the opposite. Most health plans cover the cochlear implant and several are now changing their policy to include bilateral cochlear implants. Since you have a self-insured plan, they can purchase whatever health plan they want. Do you have an option to enroll in another health plan or does your employer only offer one plan? You can argue that most of the Blue Cross, Blue Shield plans, United Healthcare, Aetna, CIGNA, Great West, Medicare, State Medicaid's and many other health insurance plans allow benefits for the cochlear implant. You can also check into State Laws that may be in place to protect individuals with disabilities. It is very difficult to work with self-funded plans because the employer dictates the coverage benefits. I think your only option is to present good arguments to your employer as to why they should cover cochlear implants and how your son has benefited from use of the CI. A number of years ago, I was a state employee of WI. Beginning in the late 1980's, the state put a specific exclusion in the uniform benefits upon which all insurers of state workers bid. Later, in 1994, the uniform benefit was changed, taking away the HA benefit in exchange for reduced co-payments for prescriptions. Long about 1995, when I began my serious quest for a CI, it began educating the powers that be who made up the State Group Insurance Board. I used statistics and numbers as best I could compile them in making the argument this was a PUBLIC POLICY issue of great importance. It was my belief that the state worker benefits were the " gold standard " that insurers of our great state looked up to. Once lawmakers began getting distressed calls from parents seeking insurance help to have children implanted, I just happened to be the person who they were referred to for information in my role as the CI chapter leader for WI CI. Anyway, long story short...I received a phone call on Good Friday of 2002, informing me that the Group Insurance Board was reviewing my data and quite possibly would be making benefit changes. In 2003 this is exactly what happened...the CI became a covered benefit! Feel free to write to me off list. This is a BIG issue that needs to be tackled by everyone who is in a place they can do the " public awareness " and " education " needed to effect change. I wish you the best! Do keep us posted! Warmly, Carol in WI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 28, 2006 Report Share Posted November 28, 2006 : One more thought comes to mind. You might want to contact Cochlear at 800-523-5798 and ask for the Reimbursement Department. They can learn more about your situation and help/coach you in this situation. Again, I wish you all the best. Keep us posted as to your efforts and results! Warmly, Carol in WI _____ From: carol burns [mailto:burnsca@...] On Behalf Of lvmyci@... Sent: Tuesday, November 28, 2006 3:28 PM Cc: lobertk@... Subject: Insurance exclusions Hi : It sounds like your company just wants to purchase a less expensive health plan for its employees because it is not true that most health plans exclude the cochlear implant. In fact, it is quite the opposite. Most health plans cover the cochlear implant and several are now changing their policy to include bilateral cochlear implants. Since you have a self-insured plan, they can purchase whatever health plan they want. Do you have an option to enroll in another health plan or does your employer only offer one plan? You can argue that most of the Blue Cross, Blue Shield plans, United Healthcare, Aetna, CIGNA, Great West, Medicare, State Medicaid's and many other health insurance plans allow benefits for the cochlear implant. You can also check into State Laws that may be in place to protect individuals with disabilities. It is very difficult to work with self-funded plans because the employer dictates the coverage benefits. I think your only option is to present good arguments to your employer as to why they should cover cochlear implants and how your son has benefited from use of the CI. A number of years ago, I was a state employee of WI. Beginning in the late 1980's, the state put a specific exclusion in the uniform benefits upon which all insurers of state workers bid. Later, in 1994, the uniform benefit was changed, taking away the HA benefit in exchange for reduced co-payments for prescriptions. Long about 1995, when I began my serious quest for a CI, it began educating the powers that be who made up the State Group Insurance Board. I used statistics and numbers as best I could compile them in making the argument this was a PUBLIC POLICY issue of great importance. It was my belief that the state worker benefits were the " gold standard " that insurers of our great state looked up to. Once lawmakers began getting distressed calls from parents seeking insurance help to have children implanted, I just happened to be the person who they were referred to for information in my role as the CI chapter leader for WI CI. Anyway, long story short...I received a phone call on Good Friday of 2002, informing me that the Group Insurance Board was reviewing my data and quite possibly would be making benefit changes. In 2003 this is exactly what happened...the CI became a covered benefit! Feel free to write to me off list. This is a BIG issue that needs to be tackled by everyone who is in a place they can do the " public awareness " and " education " needed to effect change. I wish you the best! Do keep us posted! Warmly, Carol in WI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2007 Report Share Posted May 22, 2007 So Aetna doesn't paid?? Mike http://www.aetna.com/cpb/medical/data/1_99/0013.html Clinical Policy Bulletin: Cochlear Implants and Auditory Brainstem Implants Number: 0013 Policy Auditory Brainstem Implant Aetna considers an auditory brainstem implant (ABI) medically necessary in those members 12 years of age or older who have lost both auditory nerves due to disease (e.g., neurofibromatosis or von Recklinghausen's disease). Cochlear Implant Aetna considers uniaural (monaural) cochlear implantation a medically necessary prosthetic for adults aged 18 years and older with bilateral, pre- or post-linguistic, sensorineural, moderate-to- profound hearing impairment who meet both of the following criteria: Member has bilateral severe to profound sensorineural hearing loss determined by a pure tone average of 70 dB or greater at 500 Hz, 1000 Hz, and 2000 Hz; and Member has limited benefit from appropriately fitted binaural hearing aids. Limited benefit from amplification is defined by test scores of 40 % correct or less in best-aided listening condition on open-set sentence cognition (e.g., Central Institute for the Deaf (CID) sentences, Hearing in Noise Test sentences (HINT)). Aetna considers uniaural (monaural) cochlear implantation a medically necessary prosthetic for children 12 months of age or older with bilateral sensorineural hearing impairment who meet all of the following criteria: Child has profound, bilateral sensorineural hearing loss determined by a pure tone average of 90 dB or greater at 500, 1000 and 2000 Hz and Child has limited benefit from appropriately fitted binaural hearing aids. For children 4 years of age or younger, limited benefit is defined as failure to reach developmentally appropriate auditory milestones measured using the Infant-Toddler Meaningful Auditory Integration Scale, the Meaningful Auditory Integration Scale, or the Early Speech Perception test, or less than 20% correct on open-set word recognition test (Multisyllabic Lexical Neighborhood Test) in conjunction with appropriate amplification and participation in intensive aural habilitation over a 3 to 6 month period. For children older than 4 years of age, limited benefit is defined as less than 12% correct on the Phonetically Balanced-Kindergarten Test, or less than 30% correct on the Hearing in Noise Test for children, the open- set Multi-syllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT), depending on the child's cognitive ability and linguistic skills; and A 3- to 6-month hearing aid trial has been undertaken by a child without previous experience with hearing aids. Note: When there is radiological evidence of cochlear ossification, this requirement may be waived at Aetna's discretion. The following additional medical necessity criteria must also be met for uniaural (monaural)cochlear implantation in adults and children: The member must have no medical contraindications to cochlear implantation (e.g., cochlear aplasia, active middle ear infection); and The member must have had an assessment by an audiologist and from an otolaryngologist experienced in this procedure indicating the likelihood of success with this device; and Candidates must be enrolled in an educational program that supports listening and speaking with aided hearing; and Arrangements for appropriate follow-up care including the long-term speech therapy required to take full advantage of this device, must be assured. (Note: Particular plans may place limits on benefits for speech therapy services. Please consult plan documents for details.) Aetna considers bilateral (binaural) cochlear implantation experimental and investigational because its clinical value has not been established. Note: A cochlear implant includes external components (i.e., a speech processor, a microphone headset and an audio input selector). Replacement of a cochlear implant and/or its external components is considered medically necessary when the existing device cannot be repaired or when replacement is required because a change in the member's condition makes the present unit non-functional and improvement is expected with a replacement unit. Separate assessment will be performed of the medical necessity of recommended accessories and upgrades for a cochlear implant. The member's current condition, the member's capabilities with his/her current cochlear implant, and the member's capabilities of the upgrade or accessory will be considered in determining whether the upgrade or accessory offers clinically significant benefits to the member. The requirement that the member be evaluated by a participating otolaryngologist and audiologist applies only to network plans; all others require documentation of hearing loss which is likely to be improved with the implant. Note: For adults and children, a post-cochlear implant rehabilitation program is medically necessary to achieve benefit from the cochlear implant. The rehabilitation program usually consists of six to ten sessions that last approximately two and a half hours each. Background The cochlear implant is an electronic prosthesis that stimulates cells of the auditory spiral ganglion to provide a sense of sound to persons with hearing impairment. The patient selection criteria for cochlear implants described above were adapted from the FDA approved indications for cochlear implants. The Centers for Medicare and Medicaid Services (2005) has determined that the evidence is adequate to conclude that cochlear implantation is reasonable and necessary for the treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of 40% correct or less in the best-aided listening condition on tape recorded tests of open-set sentence cognition. Audiologic criteria for pediatric patients follow guidelines similar to those for adults. For adults and children able to respond reliably, standard pure-tone and speech audiometry tests are used to screen likely candidates. For children, the speech reception threshold (SRT) and/or pure-tone average (PTA) should equal or exceed 90 dB; for adults, the SRT/PTA should equal or exceed 70 dB. If the patient can detect speech with best-fit hearing aids in place, a speech-recognition test in a sound field of 55 dB hearing level (HL) sound pressure level (SPL) is performed. A number of speech recognition tests are in current use. One of the most commonly used speech recognition tests is the Hearing In Noise Test (HINT), which tests speech recognition in the context of sentences. This test uses common, simple sentences such as " How are you feeling? " or " The weather looks good today. " HINT reliably and efficiently measures word recognition abilities to determine cochlear implant candidacy. HINT consists of 25 equivalent 10- sentence lists that may be presented in either condition (i.e., quiet, noise) to assess sentence understanding. The HINT test is first administered in quiet, using 2 lists of 10 sentences, scored for the number of words correctly identified. HINT in noise uses sentences administered at +10 signal to noise ratio (Sargent, 2000). For adults, the current cutoff for cochlear implant candidacy is a HINT score of less than 40%; for children, the current cutoff is a score less than 30%. Alternatives to the HINT test for assessing open-set sentence recognition include the CUNY Sentence Test and CID Test. The words and sentences used for these tests are recorded on tape and used by all cochlear implant centers. All of the tests are of a man's voice and played at the 70 Decibel range. CID (Central Institute for the Deaf) test consists of a list of 20 sentences. Unlike HINT sentences, CID sentences are uncommon sentences that you would not hear on a regular basis. An example of this type of sentence would be something like this: " The vacuum is in the back of the closet " or " The book is on the top shelf next to the pencil. " The CUNY Sentence Test was developed by the City University of New York and consists of 72 lists with 12 sentences each. Each list contains 102 words and is scored for the total number of words correctly identified. The Phonetically Balanced-Kindergarten Test (PBK), an open-set test of word recognition is typically included in test batteries designed to assess the speech perception skills of profoundly deaf children with cochlear implants. The PBK Test has been used for almost 50 years to assess spoken word recognition performance in children with hearing impairments. The PBK contains 50 monosyllabic words that the child repeats. PKB is most appropriate for children aged 5-7 years. The Lexical Neighborhood Test (LNT) and the Multi-syllabic Lexical Neighborhood Test (MLNT), developed by Indiana University in 1995, are two new open-set tests of word recognition. These tests include words that the child repeats, and have been used to assess recognition of individual words and phonemes in children who are cochlear implant candidates. The LNT and MLNT are based on the lexical characteristics of word frequency and neighborhood density, and include words found in the vocabularies of children age three to five. Results from these tests with pediatric cochlear implant users have shown that their lexicons appear to be organized into similarity neighborhoods, and these neighborhoods are accessed in open-set word recognition tests. Studies have shown that normal hearing three- and four-year old children are able to recognize all the words from these two open-set speech perception tests at very high levels of performance. Therefore, these results have been used as a benchmark for children with hearing impairments. Children should be receptive to wearing a hearing aid before cochlear implantation because all current implants require an external processor. A period of hearing aid use to ascertain development of aided communication ability is the critical criterion for determining candidacy of young children. For adults and children, a post-cochlear implant rehabilitation program is necessary to achieve benefit from the cochlear implant. The rehabilitation program consists of six to ten sessions that last approximately two and a half hours each. The rehabilitation program includes development of skills in understanding running speech, recognition of consonants and vowels, and tests of speech perception ability. The auditory brainstem implant (ABI) is a modification of the cochlear implant, in which the electrode array is placed directly into the brain. The FDA has approved the Nucleaus 24 Multichannel Auditory Brainstem Implant (Cochlear Corporation, Englewood, CO) for use in patients suffering from neurofibromatosis type 2, who have developed tumors on both auditory nerves. When these tumors are surgically removed it is often necessary to remove parts of the auditory nerve resulting in total deafness. Hearing aids and standard cochlear implants are not effective in these patients. In clinical studies submitted to the FDA, 82% of the 90 patients implanted with the Nucleus 24 Auditory Brainstem Implant System were able to detect certain familiar sounds, such as honking horns and ringing doorbells; 85 % were able to hear and understand conversation with the aid of lip-reading; 12% were able to hear well enough to use the phone. Of the 90 patients who received this implant 18% were not able to hear any sound. The ABI System does not restore normal hearing. It has been estimated that the incidence of meningitis caused by Streptococcus pneumoniae in pediatric cochlear recipients was over 30 times that in similarly aged children in the general population. Based on the 2002 CDC recommendation, cochlear implants recipients should receive age-appropriate vaccination against pneumococcal disease. These individuals should receive the 7-valent pneumococcal conjugate (Prevnar®) or 23-valent pneumococcal polysaccharide (Pneumovax® and Pnu-Imune®) vaccine, or both, according to ACIP schedules for persons at high risk. See CPB 037 - Pneumococcal Vaccine. There is inadequate evidence of the effectiveness of binaural cochlear implants in improving audition over uniaural (monaural) cochlear implants. Cochlear and other implant manufacturers have promoted bilateral cochlear implantation without submitting evidence of the efficacy of bilateral cochlear implants to the U.S. Food and Drug Administration (FDA) to support specific labeling. Although industry funded advocates have argued that the FDA has " approved " bilateral cochlear implants, no evidence for the efficacy of bilateral cochlear implants was presented to the FDA in granting approval for cochlear implants currently on the market. The product labeling for cochlear implants does not address bilateral implantation (hence, bilateral cochlear implants are not technically " off-label " ), and there is no evidence that the FDA contemplated bilateral implantation in granting product approval. Although in normal listeners, binaural hearing improves sound localization and speech perception, such benefits in cochlear implant users may be limited because electrical stimulation does not convey the fine temporal structure of sounds which forms the basis for detection of intraaural time differences. In addition, bilaterally- implanted patients use two separate signal processors, one controlling each ear, with independent automatic gain control circuitry. This may fail to preserve interaural differences in level accurately. The Swedish Council on Health Technology Assessment (SBU), a leading international technology assessment agency, conducted a comprehensive assessment of current evidence for bilateral cochlear implantation in children. The assessment concluded that evidence is insufficient to reach reliable conclusions about their effectiveness and safety of bilateral cochlear implants (SBU, 2006): " Scientific documentation on the benefits of bilateral cochlear implantation in children is insufficient. Well-designed, scientific studies are needed to determine whether the method yields positive effects that outweigh the increased risk for complications. " In reviewing the evidence, the SBU Report found: " Only a few scientific studies (none of which included a control group) have assessed bilateral cochlear implants. Studies using children as their own controls have reported improvements in speech perception and directional hearing when children used both implants instead of only one. However, these studies provide only low-quality evidence because of their design. Results from clinical studies on complications of unilateral CI in children showed that complication rates varied from 2 percent to 16 percent. A second cochlear implant would double the risk for complications. No studies have specifically investigated the complications or side effects from bilateral cochlear implantation. " Prospective controlled clinical outcome studies are necessary to evaluate the potential benefits of bilateral cochlear implantation. The SBU graded the quality of all of the evidence that was available until the time that the systematic evidence review was published. The systematic evidence review provided a structured review of all of the evidence, with explicit consideration of the quality of the evidence. This is the only systematic evidence review of bilateral cochlear implants by a government agency; the fact that the review was prepared by a government funded agency without any particular stake in the issue better assures that the assessment is less prone to bias in its preparation and conclusions. By contrast, industry funded advocates have made reference to the number of studies of bilateral cochlear implants without reference to the quality of that evidence, and have ignored the best available evidence, including the previously described independent systematic review and the only published randomized controlled clinical study of bilateral cochlear implants (described below). Available evidence consists mostly of small case series and individual case reports. Advocates have extensively quoted non-peer reviewed promotional literature from cochlear implant manufacturers, and the conclusions of studies are quoted while omitting the authors' significant qualifications to those conclusions. Advocates have also included abstracts and unpublished articles among cited studies. Device manufacturers have made claims that bilateral cochlear implants will substantially improve academic and social performance in the absence of any direct evidence of such a benefit. Although additional literature on bilateral cochlear implants has been published since the SBU assessment was issued (e.g., Neuman, et al., 2007; Schafer & Thibodeau, 2006; Litovsky, et al., 2006; Bauer, et al., 2006; Long, et al., 2006; Tyler, et al., 2006; Quentin Summerfield, et al., 2006), all but one of these studies are of similar strength to previous studies that were reviewed by the SBU assessment and judged to be inadequate. One of these recently published studies -- a randomized controlled clinical trial of bilateral implants in post-lingually deafened adults (Quentin Summerfield, et al., 2006) -- is of stronger design than earlier studies considered by SBU. (In theory, the benefits of bilateral cochlear implantation are more likely to be manifested in post- lingually deafened persons than pre-lingually deafened persons.) This study found that any benefits of bilateral cochlear implants were modest and offset by negative effects, such that the improvement in quality of life was insignificant. This study is important in that it is the only randomized controlled clinical study of bilateral cochlear implants published to date; randomized controlled clinical trials are considered more reliable than uncontrolled studies because they are significantly less prone to bias in interpretation of results. The study by Quentin Summerfield, et al. (2006) is also significant in that it did not only assess changes in audiologic parameters, but also assessed improvements in function and quality of life. Even though the study by Quentin Summerfield, et al. (2006) included only 24 subjects, it represents one of the largest studies of bilateral cochlear implantation published to date. Although there are approximately 100,000 cochlear implant users worldwide, no study of bilateral cochlear implantation has included 40 or more subjects, and only three published studies have included more than 30 subjects (Kuhn-Inaker, et al., 2004; Laszig, et al., 2004; Litovsky, et al., 2006). In this randomized, controlled study, Quentin Summerfield, et al. (2006) reported that any benefits of bilateral cochlear implants were modest and offset by negative effects, such that the improvement in quality of life was insignificant. In this study, adult users of unilateral Nucleus CI24 cochlear implants with the SPEAK processing strategy were randomized either to (i) receive a second identical implant in the contralateral ear immediately, or (ii) to wait 12 months while they acted as controls for late-emerging benefits of the first implant. A total of 24 subjects, 12 from each group, completed the study. Receipt of a second implant led to improvements in self- reported abilities in spatial hearing, quality of hearing, and hearing for speech, but to generally non-significant changes in measures of quality of life. The investigators concluded: " Multi- variate analyses showed that positive changes in quality of life were associated with improvements in hearing, but were offset by negative changes associated with worsening tinnitus. Even in a best-case scenario, in which no worsening of tinnitus was assumed to occur, the gain in quality of life was too small to achieve an acceptable cost- effectiveness ratio. " The conclusions of the SBU assessment are similar to the conclusions of a technical report by the American-Speech Language Hearing Association (ASHA) on cochlear implants published in 2004. The ASHA technical report found: " Bilateral implantation is currently being studied in a limited number of cochlear implant recipients with mixed results. In some cases, recipients do experience enhanced speech understanding, especially in noise; in other users the improvement in speech understanding compared with unilateral performance is minimal or absent and the primary advantage of binaural implantation is sound localization. Bilateral implantation outcomes to date are encouraging but inconclusive due to the limited number of participants and the scope of the projects. There is a clear need for further exploration of the many variables that can affect the performance of people with binaural implants before widespread use is warranted. " No published evidence based guidelines from any leading medical professional organization or government agency have concluded that bilateral cochlear implants are standard of care. Industry funded advocates have made reference to recommendations from an international " consortium " of cochlear implant specialists, recommending bilateral cochlear implants for all children with profound bilateral hearing loss (Offeciers, et al., 2005). However, a review of this paper reveals no evidence that this statement represents anything more than the opinion of the six coauthors of this paper; there is nothing in the paper to indicate that it represents the position of any leading medical professional group or government agency. In addition, this paper cannot be considered an evidence-based guideline because it makes no reference to the evidence that the coauthors relied upon in reaching their conclusions, much less grade the quality of that evidence. CPT Codes / HCPCS Codes / ICD-9 Codes Auditory Brainstem Implant: CPT codes covered if criteria are met: 61875 92640 HCPCS codes covered if selection criteria are met: S2235 Implantation of auditory brain stem implant Other HCPCS codes related to the CPB: L8699 Prosthetic implant, not otherwise specified [auditory brainstem implant] ICD-9 codes covered if selection criteria are met: 237.70 - 237.72 Neurofibromatosis 388.5 Disorders of acoustic nerve Cochlear Implants: CPT codes covered if selection criteria are met: 69930 92506 92507 - 92508 92601 - 92602 92603 - 92604 92626 - 92627 92630 - 92633 Other CPT codes related to the CPB: 69714 - 69715 69717 - 69718 HCPCS codes covered if selection criteria are met: G0009 Administration of pneumococcal vaccine when no physician fee schedule service on the same day L8614 Cochlear device/system L8615 Headset/headpiece for use with cochlear implant device, replacement L8616 Microphone for use with cochlear implant device, replacement L8617 Transmitting coil for use with cochlear implant device, replacement L8618 Transmitter cable for use with cochlear implant device, replacement L8619 Cochlear implant external speech processor, replacement L8621 Zinc air battery for use with cochlear implant device, replacement, each L8622 Alkaline battery for use with cochlear implant device, replacement, each L8623 Lithium ion battery for use with cochlear implant device speech- processor L8624 Lithium ion battery for use with cochlear implant device speech processor, ear Other HCPCS codes related to the CPB: V5273 Assistive listening device, for use with cochlear implant ICD-9 codes covered if selection criteria are met: 389.10 - 389.18 Sensorineural hearing loss 389.2 Mixed conductive and sensorineural hearing loss Other ICD-9 codes related to the CPB: 381.00- 382.9 Otitis media 744.05 Anomalies of inner ear [cochlear aplasia] The above policy is based on the following references: Nikolopoulos TP, O'Donoghue GM. Cochlear implantation in adults and children. Hosp Med. 1998;59(1):46-49. Linstrom CJ. Cochlear implantation. Practical information for the generalist. Prim Care. 1998;25(3):583-617. Ruth RA. Evaluation of sensorineural hearing loss. Compr Ther. 1997;23 (11):742-749. Syms CA 3rd, House WF. Surgical rehabilitation of deafness. Otolaryngol Clin North Am. 1997;30(5):777-782. Langman AW, Quigley SM, Souliere CR Jr. Cochlear implants in children. Pediatr Clin North Am. 1996;43(6):1217-1231. Balkany T, Hodges AV, Luntz M. Update on cochlear implantation. Otolaryngol Clin North Am. 1996;29(2):277-289. Maniglia AJ. State of the art on the development of the implantable hearing device for partial hearing loss. Otolaryngol Clin North Am. 1996;29(2):225-243. No authors listed. NIH consensus conference. Cochlear implants in adults and children. JAMA. 1995;274(24):1955-1961. Gordon KA, Daya H, on RV, Papsin BC. Factors contributing to limited open-set speech perception in children who use a cochlear implant. Int J Pediatr Otorhinolaryngol. 2000;56(2):101-111. Krabbe PF, Hinderink JB, van den Broek P. The effect of cochlear implant use in postlingually deaf adults. Int J Technol Assess Health Care. 2000;16(3):864-873. Faber CE, Grontved AM. Cochlear implantation and change in quality of life. Acta Otolaryngol Suppl. 2000;543:151-153. Waltzman SB, Scalchunes V, Cohen NL. Performance of multiply handicapped children using cochlear implants. Am J Otol. 2000;21 (3):329-335. Alberta Heritage Foundation for Medical Research (AHFMR). Multichannel auditory brainstem implant. TechScan No. 30. Edmonton, AB; AHFMR; 2002. Available at: http://www.ahfmr.ab.ca/hta/hta- publications/techscans/auditory-30-00.rtf. Accessed June 5, 2002. U.S. Food and Drug Administration (FDA), Center for Devices and Radiologic Health. Nucleus 24 Auditory Brainstem Implant System. PMA No. P000015. Rockville, MD: FDA; updated March 27, 2001. Institute for Clinical Systems Integration (ICSI). Cochlear implants. Technology Assessment No. 1. Bloomington, MN: ICSI; May 1993. Available at: http://www.icsi.org/ta/T01ar.pdf. Accessed June 24, 2002. Sargent EW. Cochlear implant: Indications. eMedicine J. 2002;3(6). Available at: http://www.emedicine.com/ent/topic424.htm. Accessed June 24, 2002. Smosky WJ. Speech audiometry. eMedicine J. 2001:2(7). Available at: http://www.emedicine.com/ent/topic371.htm. Accessed June 24, 2002. Grayeli AB, Bouccara D, Kalamarides M, et al. Auditory brainstem implant in bilateral and completely ossified cochleae. Otol Neurotol. 2003;24(1):79-82. Centers for Disease Control and Prevention (CDC). Use of vaccines for the prevention of meningitis in persons with cochlear implants. Fact Sheet for Health Care Professionals. Atlanta, GA: CDC; July 31, 2003 (previously published October 2002). Available at: http://www.cdc.gov/nip/issues/cochlear/cochlear-hcp.htm. Accessed January 9, 2004. Reefhuis J, Honein MA, Whitney CG, et al. Risk of bacterial meningitis in children with cochlear implants, USA 1997--2002. N Engl J Med. 2003;349(5):435--445. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices. Pneumococcal vaccination for cochlear implant candidates and recipients: Updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2003;52(31):739-740. Tyler RS, Dunn CC, Witt SA, Preece JP. Update on bilateral cochlear implantation. Curr Opin Otolaryngol Head Neck Surg. 2003;11(5):388- 393. BS, Lawson DT, Muller JM, et al. Cochlear implants: Some likely next steps. Annu Rev Biomed Eng. 2003;5:207-249. National Institute for Clinical Excellence (NICE). Auditory brain stem implants. Interventional Procedure Consultation Document. London, UK: NICE; June 2004. Available at: http://www.nice.org.uk/page.aspx?o=118148. Accessed May 26, 2004. Canadian Coordinating Office of Health Technology Assessment (CCOHTA). Auditory brain stem implants. Pre-assessment No. 36. Ottawa, ON: CCOHTA; June 2004. Available at: http://www.ccohta.ca/. Accessed June 24, 2004. van Hoesel RJ. Exploring the benefits of bilateral cochlear implants. Audiol Neurootol. 2004;9(4):234-246. de Vries CS. Cochlear implants in adults. Bazian, Ltd, eds. London, UK: Wessex Institute for Health Research and Development, University of Southampton; 2003:1-12. Centers for Medicare and Medicaid Services (CMS). Decision memo for cochlear implantation (CAG-00107N). National Coverage Analyses. Baltimore, MD: CMS; April 4, 2005. Available at: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=134. Accessed April 6, 2005. National Institute for Clinical Excellence (NICE). Auditory brain stem implants. Interventional Procedure Guidance 108. London, UK: NICE; January 2005. Papsin BC. Cochlear implantation in children with anomalous cochleovestibular anatomy. 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ASHA Technical Report. Rockville, MD: ASHA; 2004:1-35. Available at: http://www.asha.org/NR/rdonlyres/215CC9B8-6831-494F-83ED- E02A6832A8A9/0/24402%A01.pdf. Accessed January 30, 2007. Kuhn-Inacker H, Shehata-Dieler W, Muller J, Helms J. Bilateral cochlear implants: A way to optimize auditory perception abilities in deaf children? Int J Pediatr Otorhinolaryngol. 2004;68:1257-1266. Laszig R, Aschendorff A, Stecker M, et al. Benefits of bilateral electrical stimulation with the nucleus cochlear implant in adults: 6- month postoperative results. Otol Neurotol. 2004;25:958-968. Litovsky RY, stone PM, Godar S. Benefits of bilateral cochlear implants and/or hearing aids in children. Int J Audiol. 2006;45 (Suppl):78-91. Litovsky RY, stone PM, Godar S. Bilateral cochlear implants in children: Localization acuity measured with minimum audible angle. Ear Hear. 2006;27:43-59. Au DK, Hui Y, Wei WI. 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