Policy Expansion and Cochlear Implant Utilization: A National Medicare Analysis (2012-2024)

OBJECTIVE: To evaluate trends in cochlear implant (CI) utilization, provider participation, billing distribution, and inflation-adjusted Medicare part B professional payment following the 2019 FDA and 2022 Medicare eligibility expansions. STUDY DESIGN: Retrospective interrupted time-series analysis using national Medicare fee-for-service claims. SETTING: US Medicare part B fee-for-service claims. PATIENTS: Medicare fee-for-service beneficiaries receiving CI services identified by CPT 69930 from 2012 to 2024; provider and state identifiers were used for distributional analyses. INTERVENTIONS: None; policy exposure analysis only. MAIN OUTCOME MEASURES: Inflation-adjusted Medicare part B professional payment per service, total part B professional payments, procedure volume, provider counts, mean provider volume, billing-state service distribution, reimbursement ratios, and descriptive comparator trends for hypoglossal nerve stimulation (HGNS). RESULTS: Inflation-adjusted Medicare part B professional payment per CI service did not increase significantly after 2019; segmented regression showed a nonsignificant trend toward slope decline (-$172.2/year; P=0.08), while reimbursement ratios remained largely stable. Procedure volume increased to 5918 services in 2024, with total Medicare payments rising to approximately $21 to 22 million without a proportional per service increase. Billing-state mapping demonstrated broader post-2019 service distribution, with more states recording CI services, while mean provider volume remained relatively stable despite growth in the number of unique providers. HGNS, presented descriptively, showed contemporaneous increases in reimbursement and utilization. CONCLUSIONS: Regulatory and coverage expansions were associated with broader billing distribution and increased utilization without sustained growth in inflation-adjusted payment per service. These findings suggest that eligibility expansion alone may not address the broader institutional, geographic, and reimbursement factors that shape scalable CI delivery. LEVEL OF EVIDENCE: Retrospective observational claims analysis; not classifiable within traditional clinical evidence hierarchies.