Transcranial magnetic stimulation (TMS)

Coverage varies depending on plan

Applies to: 

Group HMO, EPO, POS and PPO members

Individual MyPriority® HMO, POS and PPO members 

Medicare Advantage plan members

Definition

From the Mayo Clinic: Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven't been effective.

TMS policy

Medical necessity criteria

The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for TMS, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies (above).

TMS authorizations

Authorization is required. Requests must include:

  • Relevant clinical documentation
  • A copy of the depression screening tool completed by the member
  • Notation of all medication trials that have been completed

In-network providers

In-network providers can request authorization for mental health and substance use disorder services, evaluations and discharges using GuidingCare.

Request an authorization

Out of network providers

Out of network providers request mental health and substance use disorder services using our authorization request forms.