ΨΥΧΗΣ ΙΑΤΡΕΙΟΝ

National Coverage Determination (NCD) for Tinnitus Masking -

RETIRED (50.6)

Tinnitus Masking is not considered reasonable and necessary for the diagnosis or treatment of an injury or disease.

Tinnitus Masking (CPT code 92599 (unspecified otolaryngologic procedure)) is noted as a noncovered service.

 

Some of the emerging techniques and associated tools are considered investigational and this LCD does NOT endorse such procedure.

 

 •  NOTE: An Advance Beneficiary Notice

    (ABN) is required for items and services

    not covered by Medicare due to being

    considered not medically reasonable and

    necessary.

           ◦  The beneficiary should be

               thoroughly educated about the

               benefits and risks of this item or

               service.

           ◦  If such notice is not given, providers may

              not shift financial liability for such items

              or services to beneficiaries  should a

              claim for such items or services be

              denied by Medicare.

Indications:

• Tinnitus masking is considered an

   experimental therapy at this time because

   of the lack of controlled clinical trials

   demonstrating effectiveness and the

   unstudied possibility of serious toxicity in

   the form of noise induced hearing loss.

• Therefore, it is not covered.

• (Rev.180, Issued: 03-06-15, Effective:

   12-18-14, Implementation: 04-06-15)

• Effective December 18, 2014, NCD 50.6 is

   deleted.

Discussion:

• A tinnitus masker is a device designed to be

  worn like a behind-the-ear hearing aid by

  persons seeking relief from

  tinnitus.

• Tinnitus is the perception of noise in the ear

   and/or head area.

• The masker produces external sounds to

   distract the person from the tinnitus.

• By producing an external sound a few

   decibels above the person's audible

   threshold, tinnitus masking is thought to

   provide sufficient distraction from

   subjective idiopathic tinnitus to alleviate the

   discomfort and debilitation associated with

   endogenous sounds within the ear and/or

   head area.

• AMA CPT Copyright Statement

• CPT codes, descriptions and other data only

   are copyright 2015 American Medical

   Association (or such other date of

   publication of CPT). All Rights Reserved.

CPT/HCPCS Codes:

 92599 - Unspecified otolaryngologic

                 procedure.

ICD-10 CM Codes that support medical necessity:

Group 1 Codes

H93.11

H93.12

H93.13

H93.19

Documentation Requirements:

• The patient's medical record must contain

   documentation that fully supports the

   medical necessity for services included

   within this NCD. (See "Indications and

   Limitations of Coverage.")

• This documentation includes, but is not

   limited to, relevant medical history, physical

   examination, and results of pertinent

   diagnostic tests or procedures.

Treatment Logic:

• Benefits are not available for Tinnitus

   Masking or similar treatments as these

   procedures are not considered reasonable

   and necessary for the diagnosis or

   treatment of an injury or disease.

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