Currentpriority healthPolicy N/A

Tinnitus Retraining Therapy Coverage Policy

This policy governs coverage of tinnitus retraining therapy (TRT) for members covered by Priority Health products; it states the clinical stance and coding guidance for payers and providers.

Policy Summary

Payerpriority health

PolicyTinnitus Retraining Therapy Coverage Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 28, 2004

Next Review DateN/A

Key ActionWhen prior authorization is required, providers must submit a request demonstrating medical necessity per the Priority Health Provider Manual.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredcoverage stance

92625assessment code

4-6 visitscounseling course

H93.11-.19diagnosis codes

Coverage Determination

Not covered — investigational/unproven

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Tinnitus retraining therapy (TRT) is investigational and not a covered benefit. Claims for TRT may be denied. Examples of procedure and DME codes that have been billed for TRT and are not covered include CPT/HCPCS code 92625 (assessment of tinnitus, includes pitch, loudness matching, and masking) and codes frequently used to bill treatment or devices such as 92700 (unlisted otorhinolaryngological service or procedure), 97039 (unlisted modality), V5298 (hearing aid, not otherwise classified), V5299 (hearing service, miscellaneous), and E1399 (durable medical equipment, miscellaneous).

Relevant Codes

ICD-10 Codes that apply to this policyICD-10

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

HCPCS/CPT Procedure CodesCPT

92625

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

Codes billed for treatments above are not covered (list 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

Provider Requirements and Billing Notes

Prior Authorization

Prior Authorization May Be Required

Prior authorization may be required by product. When prior authorization is required, the provider must submit documentation to demonstrate medical necessity per Priority Health policy and the Provider Manual.

Prior authorization requirements vary by product and service — check member benefits and the Priority Health Provider Manual.
Submit prior authorization requests per Priority Health processes; include clinical rationale and supporting records.

Note

Providers should review product-specific requirements and follow Priority Health guidance for submitting requests and documentation. Contact Provider Services or refer to the Provider Manual for additional provider actions when uncertainty exists.

Documentation Required

Prior Authorization and Required Documentation

When prior authorization is required, include complete documentation to support medical necessity. Provide clinical records, test results, treatment history, and any other documentation that substantiates the requested service.

Include relevant clinical notes and diagnostic testing results.
Provide prior treatment history and rationale for the requested procedure or device.
Attach explanatory notes when billing codes listed as not covered are used.

Denial Risk

Coverage Exclusion Triggers Denial

Claims for tinnitus retraining therapy (TRT) and listed related procedure codes are not covered and may be denied. Examples of codes that may trigger denial include, but are not limited to: 92625, 92700, 97039, V5298, V5299, E1399. Explanatory notes must accompany claims billed with these codes; absence may result in denial.

92625 — Assessment of tinnitus (includes pitch, loudness matching, and masking)
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

Background

Tinnitus retraining therapy (TRT) is a neurophysiological behavioral approach that combines counseling with prolonged use of sound enrichment (for example, sound generators producing white noise) to promote habituation to tinnitus rather than eliminate the perception of tinnitus. Counseling in TRT commonly requires multiple sessions over an extended course of treatment.

Definitions

White noise generator — device details

DeviceWhite noise generator

DescriptionProduces white noise and is used over several months to aid habituation of tinnitus; devices are selected based on tinnitus pitch, loudness and minimal masking level measured after audiogram.

FunctionUsed to counterbalance tinnitus by producing white noise set so tinnitus remains detectable to promote habituation rather than fully mask it.

Tinnitus retraining therapy (TRT) — definition

NameTinnitus retraining therapy (TRT)

DefinitionA combined counseling and sound-enrichment (masker) approach based on Jastreboff's neurophysiologic model that aims to retrain cortical and subcortical associations to achieve habituation of tinnitus perception rather than eliminate the tinnitus.

Typical courseCounseling commonly requires four to six one-hour visits over approximately an 18-month period; maskers are set so tinnitus remains perceptible to enhance habituation.