HCPCS Level II › L codes L8627 Cid ext speech process replCochlear implant, external speech processor, component, replacement
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 2 units per day (policy), rationale: Anatomic Consideration Outpatient hospital: max 2 units per day (policy), rationale: Anatomic Consideration Medicare pricing for L8627 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, prosthetics and orthotics (PO): non-rural $8,328.59 to $8,805.87 in the contiguous states; $8,288.20 to $8,386.34 in AK, HI, PR and VI; ceiling $10,341.50, floor $7,756.13 Payer policies and prior authorization for L8627 15 of 15 payer prior-auth lists that name L8627 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Humana, Rocky Mountain Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Blue Cross Blue Shield of Arizona (AZ Blue) Federal Employee Program (FEP) AZ prior auth under conditions FEP Blue Focus only Sep 1, 2026 Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) Blue Cross and Blue Shield of Illinois Blue Cross Community Health Plans (BCCHP), Illinois Medicaid IL prior auth required Oct 1, 2026 Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 Blue Cross and Blue Shield of Illinois Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) IL prior auth required Jan 1, 2025 Procedure Code List, Effective 1/1/2025 Blue Cross and Blue Shield of Texas Texas PA exemption (gold card), outpatient, fully insured TX prior auth required Gold-card exemption available Jul 1, 2026 BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) Humana Humana Healthy Horizons LA prior auth required Jan 1, 2027 Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate Humana Humana Healthy Horizons OH prior auth required Jan 1, 2027 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list Humana Humana Healthy Horizons OK prior auth required Jan 1, 2027 Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Rocky Mountain Health Plans Rocky Mountain Health Plans CHP+ CO prior auth required Oct 1, 2026 Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth required Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 UnitedHealthcare Community Plan Indiana Hoosier Care Connect IN prior auth required Oct 1, 2026 Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 UnitedHealthcare Community Plan Indiana PathWays for Aging (MLTSS) IN prior auth required Oct 1, 2026 Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026 UnitedHealthcare Community Plan Maryland HealthChoice MD prior auth required Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 UnitedHealthcare Community Plan UnitedHealthcare Community Plan of Kentucky KY prior auth under conditions Cost over $500 Jul 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
Payer coverage policies that name L8627 L8627 appears in 22 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Capital Blue Cross, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Cochlear Implants and Auditory Brainstem Implants (0013) covered if criteria are met Aug 18, 2026 payer document Aetna Meniere's Disease and Related Disorders: Surgery (0514) not covered (range L8614-L8629) Jul 2, 2026 payer document Aetna Tinnitus Treatments (0406) not covered (range L8614-L8629) Jul 10, 2026 payer document Anthem Cochlear Implants and Auditory Brainstem Implants (CG-SURG-81) covered if criteria are met May 14, 2026 payer document Blue Cross & Blue Shield of Mississippi Cochlear Implants covered if criteria are met payer document Blue Cross Blue Shield of Massachusetts Cochlear Implant (478) listed, no stance payer document Blue Shield of California | Cochlear Implant (7.01.05) listed, no stance payer document Capital Blue Cross Cochlear Implant (MP 1.023)Procedure Codes covered if criteria are met Sep 1, 2026 payer document Centene Cochlear Implant Replacements (CP.MP.14) covered if criteria are met May 1, 2025 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Cochlear Implant (SUR714.004)HCPCS Codes L8614, L8615, L8616, L8617, L8618, L8619, L8621, L8622, L8623, L8624, listed, no stance Jan 1, 2026 payer document Regence Cochlear Implant (Surgery 08) listed, no stance May 1, 2026 payer document Regence Cochlear Implant listed, no stance payer document UnitedHealthcare Cochlear Implants (2026T0070II) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (CS019.T) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Kansas Only) (CS019KS.03) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Kentucky Only) (CS019KY.11) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Nebraska Only) (CS019NE.U) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (for New Jersey Only) (CS019NJ.R) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Cochlear Implants (for New Mexico Only) (CS019NM.D) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Ohio Only) (CS019OH.E) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Pennsylvania Only) (CS019PA.S) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Cochlear Implants (for Tennessee Only) (CS019TN.S) listed, no stance Sep 1, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Jul 1, 2026: PA removed, Humana Oct 13, 2023: PA removed, humana:pa:commercial Medicaid fee-for-service Prior authorization required or conditional in CO, FL, IL, IN, KY, LA, MS, ND, OH, VA, WA, WY.
AZ: $7377.64 (dme), effective Oct 1, 2026 CO: $5409.31 (chp_plus, non-facility), effective Jul 1, 2026 FL: $6216.03 (hearing, non-facility), effective Apr 6, 2026 IL: $6084.12 (dme), effective Jan 1, 2026 IN: $7320.76 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KS: $6752.66 (default), effective Jul 1, 2026 KY: $6279.07 (dme), effective Jan 1, 2026 LA: $5241.82 (dme), effective Jul 1, 2012 MS: $6817.94 (comprehensive), effective Jul 1, 2026 ND: $0.00 (dme), effective Aug 1, 2026 NY: $4322.80 (hearing_aid, facility), effective Jul 1, 2026 OH: $5473.60 (dme), effective Jan 1, 2016 OK: $6048.61 (dme), effective Jan 1, 2026 TX: $6366.34 (audiologist, Audiologist, non-facility), effective Jan 1, 2010 VA: $7544.30 (medical), effective Jan 1, 2024 VT: $7188.43 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $8037.09 (hearing_aids), effective Jul 1, 2026 WY: $5582.74 (professional), effective Jan 1, 2021 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.