Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Cognitive behavioral therapy (CBT) is covered for adults with subjective tinnitus that is bothersome when the condition is accepted on the claim.
The following therapies are NOT covered for the treatment of tinnitus:
- Repetitive transcranial magnetic stimulation (rTMS);
- Sound therapies* including but not limited to:
- Altered auditory stimuli
- Auditory attention training
- Tinnitus specific therapies including but not limited to:
- Tinnitus retraining therapy (TRT)
- Neuromonics tinnitus treatment (NTT)
- Tinnitus activities treatment (TAT)
- Tinnitus-masking counseling
* The Department continues covering masking devices or hearing aids containing masking features for the treatment of tinnitus, as well as hearing aids for treatment of hearing loss, with prior authorization when the condition is accepted on the claim per agency rules WAC 296-20-1101 and WAC 296-20-03001.
Tinnitus refers to the auditory experience of ringing, buzzing, roaring, or hissing in the ears. Based on the data from the National Health and Nutrition Examination Survey (NHANES), the prevalence of tinnitus in adults ranges from 7.1% to 14.6%, and the prevalence of tinnitus increases with age. Other risk factors include hypertension, smoking, loud leisure-time, firearm, and occupational noise exposure. The most commonly used or evaluated non-pharmacologic therapies for subjective, bothersome tinnitus include sound treatment (e.g., sound maskers), repetitive transcranial magnetic stimulation (rTMS), cognitive behavioral therapy (CBT), and other tinnitus-specific therapies, which typically combine counseling and sound therapy as part of a multi-component intervention.
CBT is a specific psychotherapy directed at cognitive restructuring and behavior modification, which often includes education, relaxation exercises, coping skills training, stress management, or assertiveness training. The intervention teaches patients to alter their psychological response to their tinnitus and to promote changes to reduce the distress associated with tinnitus.
Sound therapy for tinnitus is broadly described as the use of sound to alter a patient’s perception of and reaction to tinnitus. This category includes sound maskers, altered auditory stimuli (e.g., listening to frequency-altered music), and hearing aids that may incorporate sound-masking features.
rTMS is a neuromodulation intervention that involves the delivery of multiple electromagnetic pulses to the scalp that are targeted to specific brain regions.
Tinnitus-specific therapies refer to a group of interventions that combine components of sound therapy and counseling for the treatment of tinnitus. These include tinnitus retraining therapy, Neuromonics tinnitus treatment, tinnitus activities treatment, tinnitus-masking counseling, and others.
The State Health Technology Clinical Committee (HTCC) reviewed these non-pharmacologic therapies for the treatment of tinnitus and made determinations on May 15, 2020. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.
In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).