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National Coverage Determination (NCD) for Tinnitus Masking -

RETIRED (50.6)

Tinnitus Masking is not considered reasonable and necessary for the diagnosis or treatment of an injury or disease.

Tinnitus Masking (CPT code 92599 (unspecified otolaryngologic procedure)) is noted as a noncovered service.

 

Some of the emerging techniques and associated tools are considered investigational and this LCD does NOT endorse such procedure.

 

 •  NOTE: An Advance Beneficiary Notice (ABN) is required for items and services not covered by Medicare

     due to being considered not medically reasonable and necessary.

           ◦  The beneficiary should be thoroughly educated about the benefits and risks of this item or service.

           ◦  If such notice is not given, providers may not shift financial liability for such items or services to beneficiaries

              should a claim for such items or services be denied by Medicare.

Indications:

• Tinnitus masking is considered an experimental therapy at this time because of the lack of controlled clinical trials

  demonstrating effectiveness and the unstudied possibility of serious toxicity in the form of noise induced hearing

  loss.

• Therefore, it is not covered.

• (Rev.180, Issued: 03-06-15, Effective: 12-18-14, Implementation: 04-06-15)

• Effective December 18, 2014, NCD 50.6 is deleted.

Discussion:

• A tinnitus masker is a device designed to be worn like a behind-the-ear hearing aid by persons seeking relief from

  tinnitus.

• Tinnitus is the perception of noise in the ear and/or head area.

• The masker produces external sounds to distract the person from the tinnitus.

• By producing an external sound a few decibels above the person's audible threshold, tinnitus masking is thought to

   provide sufficient distraction from subjective idiopathic tinnitus to alleviate the discomfort and debilitation

   associated with endogenous sounds within the ear and/or head area.

• AMA CPT Copyright Statement

• CPT codes, descriptions and other data only are copyright 2015 American Medical Association (or such other date

   of publication of CPT). All Rights Reserved.

CPT/HCPCS Codes:

 92599 - Unspecified otolaryngologic procedure.

ICD-10 CM Codes that support medical necessity:

Group 1 Codes

H93.11

H93.12

H93.13

H93.19

Documentation Requirements:

• The patient's medical record must contain documentation that fully supports the medical necessity for services

   included within this NCD. (See "Indications and Limitations of Coverage.")

• This documentation includes, but is not limited to, relevant medical history, physical examination, and results of

   pertinent diagnostic tests or procedures.

Treatment Logic:

• Benefits are not available for Tinnitus Masking or similar treatments as these procedures are not considered

   reasonable and necessary for the diagnosis or treatment of an injury or

   disease.

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