Transcranial magnetic stimulation (TMS)
Coverage varies depending on plan
Group HMO, EPO, POS and PPO members
Individual MyPriority® HMO, POS and PPO members
Medicare Advantage plan members
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.
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).
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 can request authorization for mental health and substance use disorder services, evaluations and discharges using GuidingCare.
Out of network providersOut of network providers request mental health and substance use disorder services using our authorization request forms.
- ADHD services
- Autism services
- Coordination of care
- Depression diagnosis and management
- Discharge process
- Electroconvulsive therapy
- Medicaid behavioral health
- Mental health services
- Neuropsych/psychological exams, testing
- Psychological E&M of non-mental-health disorders
- Substance use disorder services
- Transcranial magnetic stimulation