Blue Cross Blue Shield of Minnesota Medical Policy


Medical Policy:
Selected Treatments for Tinnitus
Effective Date:
June 1, 2020
Issued Date:
May 31, 2021
Last Revision Date:
May 2020
Annual Review:
May 2021

This policy version was replaced May 30, 2022. To find the newest version, go to, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

A variety of non-pharmacologic treatments are being evaluated to improve the symptoms of tinnitus. Tinnitus describes the perception of any sound in the ear in the absence of an external stimulus and is a malfunction in the processing of auditory signals. In the majority of cases, tinnitus is subjective, in that it can be heard only by the patient, and is frequently self-limited. A hearing impairment, often noise-induced or related to aging, may be associated with tinnitus.

Most patients habituate to tinnitus; however, others may seek medical care if the tinnitus becomes too disruptive. Treatment has focused on counseling or use of tinnitus maskers that produce a broad band of continuous external noise that diverts attention or masks the tinnitus. Transcutaneous electrical stimulation to the external ear, transmeatal low-power laser irradiation, electromagnetic energy, transcranial direct current stimulation, and transcranial magnetic stimulation have also been proposed for the treatment of tinnitus.

Tinnitus retraining focuses counseling and behavioral retraining on the associations induced by tinnitus perception. The goal is not to eliminate the tinnitus itself, but to retrain the subcortical and cortical centers involved in processing the tinnitus signals. As part of the overall therapy, maskers are used to induce habituation to the tinnitus. In contrast to the typical use of maskers, in retraining therapy, the masker is not intended to drown out or mask the tinnitus, but is set at a level such that the tinnitus can still be detected. This strategy is thought to enhance habituation by increasing the neuronal activity within the auditory system such that the tinnitus is difficult to detect.

NOTE: This policy does not address pharmacologic treatment of tinnitus (e.g., the use of neurotoxins, amitriptyline or other tricyclic antidepressants).

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

Treatment of tinnitus with any of the following is considered EXPERIMENTAL/INVESTIGATIVE due to the lack of clinical evidence demonstrating an impact on improved health outcomes:

  • electrical stimulation
  • electromagnetic energy
  • tinnitus maskers
  • tinnitus retraining
  • transcranial magnetic stimulation
  • transmeatal laser irradiation
  • transcranial direct current stimulation
E1399 S8948

Denial Statements

No additional statements.


Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.

Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.

Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites. 

Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 

These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.


CPT® codes copyright American Medical Association® 2022. All rights reserved.

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