Currentpriority healthPolicy NO. 91482

TREATMENT OF TINNITUS

Defines Priority Health's coverage determinations for management of chronic subjective bothersome tinnitus, specifying medically necessary interventions, investigational/not medically necessary treatments (including TRT, CBT, neuromodulation, sound therapy, acupuncture, etc.), limits related to hearing aid rider, and CMS/LCD references. This is part 1 of 2 and covers background, evidence summaries, inclusions, exclusions, and limitations.

Policy Summary

Payerpriority health

PolicyTREATMENT OF TINNITUS

Policy CodePolicy NO. 91482

Change TypeUpdated inclusions & investigational exclusions

Effective Date06/01/2026

Next Review Date

Key ActionConfirm member-specific benefits and whether the Hearing Aid Rider is included for hearing aid coverage; coverage is subject to the member's plan and contract.

SourceLink

POLICY UPDATE CHANGES

Added evidence-supported management inclusions, such as patient education, audiologic evaluation, hearing aids when indicated, and pharmacologic treatment of comorbid conditions.

Added a clear experimental/investigational exclusions list, including brain implant, CBT as a tinnitus treatment, sound therapy, neuromodulation, acupuncture, biofeedback, and other alternative or device-based therapies.

Added structured sections for society guidelines, CMS considerations, and FDA context.

Updated the policy title and structure to reflect a comprehensive tinnitus management framework.

Expanded and updated the background and references to reflect current evidence and guidelines.

1Policy Number

MultipleInterventions not medically necessary

4Medically necessary components

1Covered diagnostic CPTs

13Not medically necessary CPT/HCPCS

4ICD-10 tinnitus codes

Coverage Summary

Policy NO. 91482 defines Priority Health's coverage determination for the TREATMENT OF TINNITUS (chronic, subjective, bothersome tinnitus). The policy is effective 06/01/2026 with committee review and last updated on 05/13/2026, and it specifies which management components (e.g., multidisciplinary programs, audiologic evaluation, hearing-aid fitting when indicated, and pharmacologic treatment of comorbid conditions) may be considered medically necessary and which interventions are considered investigational or not medically necessary.

Key Facts

Policy NumberNO. 91482

Effective Date06/01/2026

Last Review05/13/2026

Coverage Stancemixed (medically necessary management options listed; multiple interventions considered investigational or not medically necessary)

Scope SummaryDefines Priority Health's coverage determinations for management of chronic subjective bothersome tinnitus, specifying medically necessary interventions, investigational/not medically necessary treatments (including TRT, CBT, neuromodulation, sound therapy, acupuncture, etc.), limits related to hearing aid rider, and CMS/LCD references; part 1 of 2 covering background, evidence, inclusions, exclusions, and limitations.

Medical-Necessity Criteria

Inclusions - Medically Necessary Management

Management of chronic, subjective, bothersome tinnitus may be considered medically necessary when clinically appropriate and consistent with professional society guidelines, and may include:

ALL of the following

Multidisciplinary tinnitus management programs emphasizing education, coping strategies, and shared decision-making.
Comprehensive audiologic evaluation and patient education.
Hearing aid evaluation and fitting for individuals with co-existing hearing loss.
Pharmacologic treatment of tinnitus (e.g. amitriptyline or other tricyclic antidepressants).

Not Medically Necessary / Investigational

The following management treatments for tinnitus have not been shown to be effective and are considered investigational, unproven, and not medically necessary:

ANY of the following

Acupuncture
Biofeedback including the following: Functional MRI (fMRI) Neurofeedback
Brain Implant
Cognitive Behavioral Therapy
Combined psychological and sound therapy including: Tinnitus retraining therapy (TRT)

Individual Case Review / Exceptions

Coverage exceptions may be allowed when ALL of the following are met:

ALL of the following

Request submitted for an investigational/unproven treatment that is considered promising for the member's condition
Member has terminal illness or chronic, life-threatening, severely disabling disease causing serious clinical deterioration (eligible for exception review)
Prior plan approval / prior authorization obtained and a Priority Health medical director or clinical pharmacist reviews and approves

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Coding

CMS / LCD references citedmixed

L36469	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (CGS Administrators, LLC) - cited for CMS guidance context
L33398	Transcranial Magnetic Stimulation (National Government Services) - cited
L37086	Repetitive Transcranial Magnetic Stimulation (Noridian Healthcare Solutions) - cited
L37088	Related Noridian LCD - cited
L34869	Repetitive Transcranial Magnetic Stimulation (Palmetto GBA) - cited
L34641	Transcranial Magnetic Stimulation (WPS Insurance Corporation) - cited

Applicable ICD-10 codesICD-10

H93.11	Tinnitus, right ear
H93.12	Tinnitus, left ear
H93.13	Tinnitus, bilateral
H93.19	Tinnitus, unspecified ear

Covered CPT/HCPCS codesCPTCovered

92625

Assessment of tinnitus (includes pitch, loudness matching, and masking)

Codes billed for treatments that are not covered (examples / not inclusive)mixedNot Covered

92700	Unlisted otorhinolaryngological service or procedure
97039	Unlisted modality (specify type and time if constant attendance)
V5298	Hearing aid, not otherwise classified
V5299	Hearing service, miscellaneous
E1399	Durable medical equipment, miscellaneous

Not Medically Necessary CPT/HCPCS (listed)CPTNot Covered

90867	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management
90868	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session
90869	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management
90875	Individual psychophysiological therapy incorporating biofeedback training by any modality with psychotherapy; 30 minutes
90876	Individual psychophysiological therapy incorporating biofeedback training by any modality with psychotherapy; 45 minutes
90901	Biofeedback training by any modality
0552T	Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional
S8948	Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes
0858T	Externally applied transcranial magnetic stimulation with concomitant measurement of evoked cortical potentials with automated report
0889T	Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation

1–10 of 13

1/2

Billing Rule

Use applicable CPT for tinnitus assessment

When performing a diagnostic tinnitus evaluation, report CPT 92625 (assessment of tinnitus: includes pitch, loudness matching, and masking).

92625

Documentation Required

Explanatory notes for certain unlisted codes

Claims billed with unlisted or miscellaneous codes (examples below) must include explanatory notes accompanying the claim.

92700
97039
V5298
V5299

Provider Actions

Documentation Required

Verify member benefits

Confirm member-specific benefits, including whether the Hearing Aid Rider is included, before recommending or billing for hearing aids; coverage is subject to the member's plan and contract.

Verify whether the member's contract includes the Hearing Aid Rider.
Coverage for hearing aids is contingent on the member's plan benefits and contract terms.

Documentation Required

Follow professional guidelines

Ensure tinnitus management follows professional society guidelines and document multidisciplinary approaches and comprehensive audiologic evaluation when pursuing medically necessary interventions.

Document multidisciplinary tinnitus management (education, coping strategies, shared decision-making).

Background & Evidence

Tinnitus is common—affecting an estimated 14.4% of the global population, with about 2.3% experiencing severe or highly bothersome symptoms—and most clinical management focuses on patients with chronic, subjective, bothersome tinnitus who have associated distress or functional impairment.

Management goals emphasize evaluation and treatment of underlying or contributing conditions, patient education, coping strategies, and symptom-focused supportive interventions (including hearing amplification for patients with co-existing hearing loss). The policy therefore emphasizes multidisciplinary care, audiologic assessment, shared decision-making, and use of medically appropriate supportive therapies.

Because multiple device-based, alternative, and neuromodulatory interventions (for example, brain implants, TMS/rTMS/TBS, tDCS, TENS, customized sound systems, TRT, acupuncture, biofeedback/fMRI neurofeedback, low-level laser, and psychedelic-assisted therapy) lack consistent, durable evidence of clinically meaningful benefit, these approaches are listed as investigational or not medically necessary and are excluded from routine coverage. Hearing aids remain a covered benefit only when the member's contract includes the Hearing Aid Rider.

Evidence Item	Summary
Multidisciplinary tinnitus management programs	Emphasizes education, coping strategies, and shared decision-making; considered part of medically necessary management when clinically appropriate and guideline-consistent.
Comprehensive audiologic evaluation and patient education	Recommended as a component of medically necessary care for chronic, subjective, bothersome tinnitus.
Hearing aid evaluation and fitting	Advised for individuals with co-existing hearing loss as part of tinnitus management.
Pharmacologic treatment of comorbid conditions	Medications (e.g., amitriptyline or other tricyclic antidepressants) may be used to treat comorbid depression, anxiety, or insomnia rather than tinnitus directly.

Tinnitus

Perception of sound (ringing, buzzing, hissing) in the absence of an external acoustic stimulus; includes subjective forms (perceived only by the patient) and rare objective forms (detectable by an examiner).

Tinnitus Retraining Therapy (TRT)

A structured habituation-based management approach combining directive counseling and sound therapy (typically delivered over ~12–18 months) intended to promote habituation rather than eliminate the tinnitus percept; protocols and outcomes vary and TRT is not established as superior to other management strategies.

Medicare / LCD References

Medicare / LCD referencesmixed

L36469	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder
L33398	Transcranial Magnetic Stimulation
L37086	Repetitive Transcranial Magnetic Stimulation
L34869	Repetitive Transcranial Magnetic Stimulation
L34641	Transcranial Magnetic Stimulation
CMS determinations	CMS determinations (refer to CMS Medicare Coverage Database)

CMS / LCD references citedmixed

L36469	Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults with Treatment Resistant Major Depressive Disorder (CGS Administrators, LLC) - cited for CMS guidance context
L33398	Transcranial Magnetic Stimulation (National Government Services) - cited
L37086	Repetitive Transcranial Magnetic Stimulation (Noridian Healthcare Solutions) - cited
L37088	Related Noridian LCD - cited
L34869	Repetitive Transcranial Magnetic Stimulation (Palmetto GBA) - cited
L34641	Transcranial Magnetic Stimulation (WPS Insurance Corporation) - cited

Revision History

2026-06-01effective_dateLatest

Policy effective date 06/01/2026

2026-05-13last_reviewLatest

Committee review / last updated 05/13/2026

added (material)Latest

Policy Summary

Payerpriority health

PolicyTREATMENT OF TINNITUS

Policy CodePolicy NO. 91482

Change TypeUpdated inclusions & investigational exclusions

Effective Date06/01/2026

Next Review Date

Key ActionConfirm member-specific benefits and whether the Hearing Aid Rider is included for hearing aid coverage; coverage is subject to the member's plan and contract.

SourceLink

On This Page

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Medically Necessary / Covered Services

Covered when ALL of the following are met:

ALL of the following

Assessment of tinnitus using procedure 92625 (includes pitch, loudness matching, and masking)
Coverage subject to member's specific benefits and plan documents; CMS determinations govern Medicare

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Limitations

ALL of the following

Hearing aids are a covered benefit only if the Hearing Aid Rider is part of the member's contract.
Coverage contingent on member's specific benefits / contract rider

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Deep Brain Stimulation (DBS)

Neuromodulation modalities

Transcutaneous electrical nerve stimulation (TENS)
Transcranial magnetic stimulation (TMS)
Repetitive transcranial magnetic stimulation (rTMS)
Theta -burst stimulation (TBS)
Transcranial direct current stimulation (tDCS)

Psychedelic- Assisted Therapy

Sound Therapy, including: Customized sound therapy

Transmeatal laser irradiation

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Not Medically Necessary / Excluded Treatments

The following procedures/services are considered not medically necessary for treatment of tinnitus:

ANY of the following

Therapeutic repetitive transcranial magnetic stimulation (TMS) - CPT 90867
Therapeutic repetitive transcranial magnetic stimulation (TMS) - CPT 90868
Therapeutic repetitive transcranial magnetic stimulation (TMS) - CPT 90869
Individual psychophysiological therapy incorporating biofeedback with psychotherapy - CPT 90875
Individual psychophysiological therapy incorporating biofeedback with psychotherapy - CPT 90876
Biofeedback training by any modality - CPT 90901
Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies - CPT 0552T
Application of low-level laser modality requiring constant provider attendance - HCPCS S8948
Externally applied transcranial magnetic stimulation with measurement of evoked cortical potentials - CPT 0858T
Personalized target development for accelerated rTMS via fMRI-guided methods - CPT 0889T
Accelerated, repetitive high-dose fMRI-guided theta-burst stimulation initial - CPT 0890T
Accelerated, repetitive high-dose fMRI-guided theta-burst stimulation subsequent - CPT 0891T
Accelerated, repetitive high-dose fMRI-guided theta-burst stimulation subsequent motor threshold redetermination - CPT 0892T

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Investigational / Experimental or Not Supported

Treatments considered experimental, investigational, or unproven for tinnitus (policy excludes coverage except by individual case review/exception):

ANY of the following

Brain implant therapies for tinnitus (listed as experimental/investigational in exclusions list)
CBT listed as a tinnitus-specific treatment (policy added CBT to exclusions list for tinnitus-specific coverage despite evidence for distress reduction in literature)
Sound therapy including customized and device-based systems (considered not medically necessary for treatment of tinnitus)
Tinnitus Retraining Therapy (TRT) (not established as standard or superior; considered not medically necessary based on evidence)
Transmeatal low-level laser irradiation / transmeatal laser stimulation (no demonstrated benefit beyond placebo)
Neuromodulation therapies (including various electrical stimulation, tDCS, TMS variants) unless otherwise specified covered
Acupuncture for tinnitus (listed in experimental/unproven exclusions)
Biofeedback and related neurofeedback interventions (listed as experimental/unproven)
Psychedelic-assisted therapy and other alternative/device-based therapies for tinnitus (listed investigational/unproven)

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Prior Authorization

Prior authorization for investigational/experimental treatments

Providers must submit prior authorization requests for investigational, experimental, or unproven tinnitus treatments. Exceptions for these therapies require individual case review and approval by a Priority Health medical director or clinical pharmacist.

Providers must submit prior authorization requests for investigational, experimental, or unproven treatments.
Individual case review and exception decisions are made by a Priority Health medical director or clinical pharmacist.

Explanatory notes must accompany claims billed with these codes.

Denial Risk

Claims for listed not medically necessary services will be denied

Claims for services listed as not medically necessary (examples below) are subject to denial unless an approved individual exception exists.

90867
90868
90869
0552T
90901

Document comprehensive audiologic evaluation when indicating hearing rehabilitation or other interventions.

Prior Authorization

Prior authorization for investigational/experimental treatments

Prior authorization is required for investigational, experimental, or unproven tinnitus treatments. Submit a prior authorization request for individual case review; determinations for exceptions will be made by a Priority Health medical director or clinical pharmacist.

Submit prior authorization for investigational or experimental treatments to request individual case review.
Required reviewers: Priority Health medical director or clinical pharmacist.

Use of amplification devices, wearable sound generators, tinnitus-matched or modified sounds, or proprietary device-based systems to reduce tinnitus awareness or distress; evidence is heterogeneous and sound therapy as a standalone disease-modifying treatment has not demonstrated consistent, durable clinical benefit.

Added evidence-supported management inclusions, such as patient education, audiologic evaluation, hearing aids when indicated, and pharmacologic treatment of comorbid conditions.

added (material)Latest

added (non-material)Latest

Added structured sections for society guidelines, CMS considerations, and FDA context.

revised (non-material)Latest

Updated the policy title and structure to reflect a comprehensive tinnitus management framework.

revised (non-material)Latest

Expanded and updated the background and references to reflect current evidence and guidelines.