Transcranial Magnetic Stimulation (TMS) reimbursement
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Defines AmeriHealth Caritas Delaware reimbursement guidance for outpatient transcranial magnetic stimulation (TMS) used to treat severe major depressive disorder in adults, including coding and diagnosis guidance and prior authorization note.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage criteria for TMS
Covered when ALL of the following are met:
ALL of the following
- Patient is age 18 years or older.
- Indication is severe major depressive disorder (ICD-10-CM F32.2 or F33.2).
- TMS is delivered using an FDA‑approved device.
- TMS is provided in an outpatient setting without anesthesia or analgesia.
Prior authorization
Coding and Billing
| F32.2 | Major depressive disorder, single episode, severe without psychotic features |
| F33.2 | Major depressive disorder, recurrent, severe without psychotic features |
Provider Actions and Requirements
Prior authorization may be required
Prior authorization may be required.
Definitions
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