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Tinnitus Treatments (CPB 0406, reviewed 2026-07-10)

Aetna·ENT (Ear, Nose & Throat), Audiology, Psychiatry +2 more·Medical Policy
Effective date
Jul 10, 2026
We identified it
Aug 18, 2026
Days to comply

Summary

Aetna updated its tinnitus treatment policy (CPB 0406, replacing CPB 478) effective 2026-07-10. The policy now covers Cognitive Behavioral Therapy (CBT) when specific criteria are met and authorizes Cortical Mastoidectomy for sigmoid sinus dehiscence, while classifying most other tinnitus interventions (including hearing aids, maskers, acoustic neuromodulation, and 40+ alternative therapies) as experimental/investigational and non-covered. Billing teams must immediately identify claims for non-covered treatments and deny or request member cost-sharing.

Action Required

Action needed
By 2026-07-10: Billing team must immediately implement Aetna tinnitus policy changes in claims processing and authorization systems. (1) Covered treatments requiring prior authorization: Update system to require authorization for CPT 97129, 97130 (CBT for tinnitus) when all four medical necessity criteria documented (persistent 6+ month tinnitus, treatable causes ruled out, clinical distress present, licensed mental health professional administers). (2) Covered surgical treatments: Authorize CPT 69502, 69505, 69511 (cortical mastoidectomy) only when imaging documents sigmoid sinus dehiscence/wall defect. (3) Non-covered/experimental treatments: Flag and deny claims for CPT 0552T, 0783T, 61850-61868, 64568-64727, 69450, 69930, 90867, 90868, 90901, 92601-92604, 95970, 95976, 97033, 97810-97814, 99183, and related codes listed in the policy. (4) Providers must document: tinnitus duration, differential diagnosis workup results, functional/quality of life impact, and provider credentials for mental health services. (5) Update encounter forms and denial templates to reference CPB 0406 specifically. Claims lacking required documentation will be denied; claims for experimental treatments will be denied or require member notification of non-covered status per contract.

Affected Billing Codes

97129
97130
61850
61860
61863
61864
61867
61868
61880
61885
61886
61888
64568
64569
64716
64727
69450
69930
90867
90868
90901
92601
92602
92603
92604
95970
95976
97033
97810
97811
97812
97813
97814
99183
69502
69505
69511
69601
69602
69603
69604
69631
69632
69633
69634
69635
69636
69637
69638
69639
69640
69641
69642
69643
69644
69645
69646