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 know before submitting claims.

Aetna's updated tinnitus coverage policy draws a sharp line between what's medically necessary and what's experimental — and the list of non-covered treatments is long. The policy covers TENS as durable medical equipment (HCPCS E0720, E0730, and supply code A4595) and cortical mastoidectomy for sigmoid sinus dehiscence, but denies reimbursement for dozens of other interventions including acupuncture (CPT 97810–97814), transcranial magnetic stimulation (CPT 90867–90868), cochlear implants for tinnitus alone, and neurostimulation procedures. If your practice treats tinnitus patients with Aetna coverage, this policy affects your charge capture, your prior authorization workflow, and your claim denial risk — starting now.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Tinnitus Treatments
Policy Code	CPB 0406
Change Type	Modified
Effective Date	September 26, 2025
Impact Level	High
Specialties Affected	Otolaryngology (ENT), Audiology, Neurology, Physical Medicine & Rehabilitation, Pain Management
Key Action	Audit active tinnitus claims for E0720/E0730 TENS billing and confirm all three medical necessity criteria are documented before September 26, 2025

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Aetna Tinnitus Treatment Coverage Criteria and Medical Necessity Requirements 2025

The Aetna tinnitus coverage policy recognizes exactly two medically necessary interventions. Everything else — and the list is substantial — is considered experimental, investigational, or unproven.

First: TENS as DME. Aetna covers transcutaneous electrical nerve stimulation billed as durable medical equipment under HCPCS E0720 (two-lead TENS device) or E0730 (four-or-more-lead TENS device), plus monthly supplies under A4595. But all three of the following criteria must be met — not two of three, all three:

#	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, including counseling and reassurance, dietary modifications, and drug therapy

That last criterion is your step therapy documentation requirement. "Tried and failed" means you need records showing each of those conservative approaches was actually attempted. A chart note that says "patient declined dietary changes" is not the same as documented failure of dietary modification.

There's also a hard utilization cap here. Aetna does not consider more than 10 TENS sessions per year medically necessary for tinnitus. This is a firm coverage limit, not a soft guideline. If you submit claims for session 11 or beyond, expect a claim denial. Build this cap into your scheduling and billing workflows now.

Second: Cortical mastoidectomy for sigmoid sinus dehiscence. Aetna covers this surgical intervention when tinnitus results from a bony defect in the mastoid or temporal bone — specifically sigmoid sinus dehiscence (sometimes called sigmoid sinus wall dehiscence), which can be caused by sigmoid diverticulum. The coverage requirement is imaging documentation of a bony defect with dehiscence of the sigmoid sinus on temporal bone imaging. No imaging documentation, no coverage. This isn't a gray area.

Prior authorization requirements aren't explicitly detailed in CPB 0406, but surgical procedures at this level routinely require prior auth under Aetna plans. Confirm prior authorization requirements with the individual plan before scheduling the mastoidectomy. If you're unsure how your specific Aetna contract handles this, loop in your compliance officer before the September 26, 2025 effective date.

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Aetna Tinnitus Treatment Exclusions and Non-Covered Indications

This is where CPB 0406 does the most billing damage. Aetna considers a wide range of tinnitus treatments experimental, investigational, or unproven — meaning no reimbursement, regardless of clinical rationale.

The non-covered list includes treatments that are commonly billed and, in some cases, commonly assumed to be covered. Here's the reality of the Aetna tinnitus coverage policy:

This is a pattern Aetna follows across several specialty-specific policies — a narrow covered indication surrounded by a long exclusion list. The risk for billing teams is assuming that because a treatment is clinically reasonable, it's covered. With CPB 0406, it often isn't.

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Coverage Indications at a Glance

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Aetna Tinnitus Billing Guidelines and Action Items 2025

The effective date of September 26, 2025 is not far off. These are the steps your billing team needs to take now.

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
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
A4595	HCPCS	Electrical stimulator supplies, 2 lead, per month (e.g., TENS, NMES)

Mastoidectomy CPT Codes (Covered for Sigmoid Sinus Dehiscence — Imaging Required)

Not Covered / Experimental CPT Codes

Not Covered / Experimental HCPCS Codes

Note: The policy data references 305 total HCPCS codes. The codes above represent those explicitly listed in the provided policy data. Pull the full code set from the CPB 0406 Aetna policy source for your complete billing reference.

ICD-10-CM Diagnosis Codes

The CPB 0406 policy data does not list specific ICD-10-CM codes. Use the appropriate tinnitus diagnosis codes from your ICD-10-CM codebook (typically under H93.1x for tinnitus) and confirm with your billing consultant that your diagnosis coding aligns with Aetna's documented criteria for each covered indication.

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