Tinnitus Treatments — CPB 0406 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0406 governing tinnitus treatments, effective September 26, 2025. Here's what billing teams need to act on now.

Aetna's tinnitus coverage policy under CPB 0406 now spells out two medically necessary interventions with hard criteria your billing team must document to avoid claim denial. The policy covers TENS as durable medical equipment (DME) — billed under HCPCS E0720 or E0730 — and cortical mastoidectomy for sigmoid sinus dehiscence. At the same time, it draws a sharp line around dozens of other tinnitus treatments, marking them experimental or unproven. If your practice bills for tinnitus-related services and has Aetna patients, this coverage policy change affects your charge capture, your prior authorization workflow, and your documentation requirements starting September 26, 2025.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Tinnitus Treatments — CPB 0406
Policy Code	CPB 0406
Change Type	Modified
Effective Date	September 26, 2025
Impact Level	Medium
Specialties Affected	Otolaryngology (ENT), Audiology, Neurology, Physical Medicine & Rehabilitation, DME suppliers
Key Action	Confirm all TENS claims for tinnitus meet the three-part medical necessity criteria and document failed conservative treatment before billing E0720 or E0730

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Aetna Tinnitus Coverage Criteria and Medical Necessity Requirements 2025

CPB 0406 Aetna sets out two covered indications for tinnitus treatment. Everything else — and there's a long list — is experimental or not medically necessary.

TENS as DME for severe tinnitus is covered, but only when your documentation supports all three of these criteria simultaneously:

#	Covered Indication Copy
1	Medically correctable causes of tinnitus have been ruled out
2	The member has experienced severe tinnitus for more than six months
3	The member has tried and failed conservative treatments — specifically counseling and reassurance, dietary modifications, and drug therapy

All three must be met. Missing documentation on any one of them gives Aetna a clean basis for denial. This is a step-therapy structure, and Aetna will apply it strictly.

The coverage policy also caps TENS sessions at 10 per year. More than 10 sessions is not considered medically necessary. Aetna's position is that evidence does not support additional clinical benefit beyond that threshold. Bill HCPCS E0720 (two-lead TENS device) or E0730 (four-or-more-lead TENS device) for the equipment, and A4595 for the monthly supply of two-lead electrical stimulator supplies.

Cortical mastoidectomy for sigmoid sinus dehiscence is the second covered indication. This applies specifically to tinnitus caused by a bony defect in the mastoid or temporal bone — what's documented in the literature as sigmoid sinus dehiscence or sigmoid sinus wall dehiscence, sometimes caused by sigmoid diverticulum. Coverage requires imaging of the temporal bone that documents the bony defect with dehiscence of the sigmoid sinus. No imaging documentation, no coverage. This isn't a soft requirement — it's a hard prerequisite for reimbursement.

If your team is asking whether Aetna prior authorization is required for these procedures, the answer is: check your specific plan contract. CPB 0406 sets the medical necessity criteria, but prior authorization requirements vary by plan. Confirm with Aetna before scheduling the mastoidectomy, especially given the surgical complexity and the cost exposure involved.

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Aetna Tinnitus Exclusions and Non-Covered Indications

This is where the policy gets expensive for practices that haven't updated their billing guidelines.

Aetna marks a wide range of tinnitus interventions as experimental, investigational, or unproven. The policy groups these together under a broad "not medically necessary" designation. Billing any of these for tinnitus will result in claim denial.

The excluded categories include:

If your providers order any of these for a primary tinnitus diagnosis and your team bills Aetna, you're looking at denial. The list is long enough that it's worth a specific audit of your tinnitus-related claims before September 26, 2025.

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Coverage Indications at a Glance

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Aetna Tinnitus Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. These are the steps your billing team needs to complete before then.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Tinnitus Treatments Under CPB 0406

Covered HCPCS Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
A4595	HCPCS	Electrical stimulator supplies, 2 lead, per month (e.g., TENS, NMES)
E0720	HCPCS	Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation
E0730	HCPCS	Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation

Not Covered / Experimental CPT Codes

Other CPT Codes Related to CPB 0406 (Mastoidectomy / Tympanoplasty Series)

Not Covered HCPCS Codes

Note: The policy data includes 305 total HCPCS codes. The codes listed above represent all codes explicitly provided in the source data. For the complete HCPCS code list under CPB 0406, review the full policy at app.payerpolicy.org/p/aetna/0406.

Key ICD-10-CM Diagnosis Codes

The policy data does not list specific ICD-10-CM codes for CPB 0406. Work with your coding team to apply the appropriate tinnitus diagnosis codes (H93.1x series) and sigmoid sinus dehiscence codes when documenting covered indications.

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