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.

Medical policy

Transcranial Magnetic Stimulation - 91563

TMS authorizations

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).

How to request authorization

Request authorization for TMS services by completing the Behavioral Health Transcranial Magnetic Stimulation Authorization form and faxing to 616.975.0249. 

Transcranial Magnetic Stimulation (TMS) for Depression Authorization Request form

Request 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