Psychological coping therapy including cognitive-behavioral therapy, self-help cognitive-behavioral therapy, tinnitus coping therapy, acceptance and commitment therapy, and psychophysiological treatment, may be considered medically necessary for persistent and bothersome tinnitus.
Treatment of tinnitus with any of the following therapies is considered investigational:
biofeedback
tinnitus maskers, customized sound therapy
combined psychological and sound therapy (eg, tinnitus retraining therapy)
transcranial magnetic stimulation,
transcranial direct current stimulation
electrical transcutaneous electrical stimulation of the ear, electromagnetic energy
transmeatal laser irradiation.
Note: This policy does not address surgical (eg, cochlear or brainstem implants) or pharmacologic (eg, use of amitriptyline or other tricyclic antidepressants) treatments of tinnitus, or injection of botulinum toxin.