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
Medicaid
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.
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.
TMS authorizations
Authorization is required. Requests must include:
- Current Diagnosis
- Onset of current depressive episode
- Dates of current or recent outpatient therapy
- A copy of the depression screening tool completed by the member
- Notation of all medication trials that have been completed
- Information regarding any medical contraindications
In-network providers
In-network providers can request authorization for TMS using GuidingCare.
Out-of-network providers
Out-of-network providers request mental health and substance use disorder services using our Transcranial Magnetic Stimulation (TMS) authorization form.- Autism services
- Community care management
- Clinical guidelines
- Coordination of care
- 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
- Telemedicine
- Transcranial magnetic stimulation