CurrentCareSource GeorgiaPolicy Transcranial Magnetic Stimulation for Treatment of Depression-MP-MM-1339

Transcranial Magnetic Stimulation for Treatment of Depression

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Medical necessity and coverage criteria for use of transcranial magnetic stimulation to treat major depressive disorder in adults, including initial, continuation, and repeat courses, and device/administration requirements for providers and payers.

Policy Summary

PayerCareSource Georgia

PolicyTranscranial Magnetic Stimulation for Treatment of Depression

Policy CodePolicy Transcranial Magnetic Stimulation for Treatment of Depression-MP-MM-1339

Change TypeRevised medication trial requirement

Effective DateJun 1, 2026

Last ReviewJun 1, 2026

Next Review DateMar 11, 2026

Key ActionObtain prior authorization documenting age, diagnosis, two adequate antidepressant trials (or intolerance), psychotherapy trial, and absence of contraindications.

SourceLink

POLICY UPDATE CHANGES

Changed medication trial prior to TMS from 4 to 2.

Updated Section II.D contraindications and references during annual review.

≥18Minimum age for coverage

2Required antidepressant trials

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CurrentCareSource GeorgiaPolicy Transcranial Magnetic Stimulation for Treatment of Depression-MP-MM-1339

Transcranial Magnetic Stimulation for Treatment of Depression

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Policy Summary

PayerCareSource Georgia

PolicyTranscranial Magnetic Stimulation for Treatment of Depression

Policy CodePolicy Transcranial Magnetic Stimulation for Treatment of Depression-MP-MM-1339

Change TypeRevised medication trial requirement

Effective DateJun 1, 2026

Last ReviewJun 1, 2026

Next Review DateMar 11, 2026

Key ActionObtain prior authorization documenting age, diagnosis, two adequate antidepressant trials (or intolerance), psychotherapy trial, and absence of contraindications.

SourceLink

POLICY UPDATE CHANGES

Changed medication trial prior to TMS from 4 to 2.

Updated Section II.D contraindications and references during annual review.

≥18Minimum age for coverage

2Required antidepressant trials

Max sessions (acute course)

Maintenance TMSNot covered

30 cmMetal fragment distance

Coverage Criteria for Transcranial Magnetic Stimulation (TMS)

Initial (Index) Course Medical Necessity

TMS is considered medically necessary when ALL of the following are met:

Primary criteria: Member is 18 years of age or older; confirmed diagnosis of major depressive disorder (single or recurrent) with a current severe episode evidenced by a recent score on a standardized depression rating scale; and one of the following: (1) treatment resistance demonstrated by lack of clinically significant response during a current or previous depressive episode after adequate trials of 2 antidepressant agents, including at least 2 different agent classes at or near the maximum effective dose and duration for each class; (2) inability to tolerate therapeutic medications documented by two trials of antidepressant agents with distinct side effects; (3) history of response to TMS in a prior depressive episode with >50% improvement on a standardized depression rating scale; or (4) currently receiving or is a candidate for and has declined electroconvulsive therapy (ECT).all

Completion of a trial of evidence-based psychotherapy for MDD at appropriate frequency and duration for 12 weeks without significant improvement (alone or with medications) is also required.

Additional Courses

Additional treatment courses are medically necessary when ALL of the following are met:

Repeat course criteria: At least 30 days have passed since the last TMS session; there is a history of response to TMS in a previous depressive episode evidenced by >50% improvement on a standardized depression rating scale; and medical necessity criteria in Section II (initial course criteria) continue to be met.all

Device and Administration

Device and administration requirements: TMS must be administered using an FDA-cleared device for the treatment of MDD according to the manufacturer’s user manual and specified stimulation parameters; a treatment course should not exceed 5 days per week for 6 weeks (total of 30 sessions) followed by a 3-week taper of 3, 2, and 1 sessions; and TMS must be ordered by and performed under the direction of a neurologist, licensed psychiatrist, or psychiatric nurse practitioner who has examined the member, reviewed the record when within scope of practice, and has experience administering TMS within scope of practice.all

TMS maintenance treatment — defined as regularly scheduled weekly, biweekly, or monthly sessions intended solely to prevent relapse after an acute or continuation course — is not considered medically necessary. This policy exclusion applies to ongoing maintenance schedules because the document does not support coverage of maintenance-only TMS outside the defined acute, continuation, or repeat-course criteria.

The policy identifies maintenance TMS as not medically necessary on the basis that there is insufficient evidence to assess net benefit versus harm in peer-reviewed literature for patients receiving maintenance (preventive) TMS. Because available studies do not adequately demonstrate overall benefit or safety for regularly scheduled maintenance sessions, continuation of coverage for such maintenance regimens is not supported.

Treatment Frequency, Duration, and Coding-related Limits

inv-06: Acute treatment course frequency/duration — Up to 5 days/week for up to 6 weeks (up to 30 sessions) with a 3-week taper (3,2,1 sessions).

FrequencyUp to 5 days per week

Maximum durationUp to 6 weeks (acute/index course)

Maximum sessions (acute/index)Total up to 30 sessions

Taper schedule3-week taper: 3 sessions in week 1, 2 sessions in week 2, 1 session in week 3

Provider Requirements, Authorization, and Documentation

Prior Authorization

Prior authorization and medical necessity review required

Prior authorization is required for both initial (index) and continuation courses of transcranial magnetic stimulation (TMS). The prior authorization request must document that the member meets the medical necessity criteria in Section II (age ≥18, confirmed MDD with current severe episode, treatment resistance/intolerance/history, completion of psychotherapy trial, absence of contraindications) and that device and session limits will be followed.

Document age (≥18) and confirmed diagnosis of MDD with a recent standardized depression rating scale score.
Document either treatment resistance (2 adequate antidepressant trials of different classes at/near maximum dose and duration), intolerance (2 trials with distinct side effects), prior TMS response, or declined ECT.
Confirm adherence to device/administration requirements and session limits (up to 30 sessions over 6 weeks with 3-week taper).

Step Therapy

Document two adequate antidepressant trials (distinct classes)

Background and Context

Transcranial magnetic stimulation (TMS) is a noninvasive, outpatient brain stimulation therapy used in the treatment of major depressive disorder. First introduced in the mid-1980s, TMS delivers brief, repetitive magnetic pulses via a coil positioned over the scalp to induce focal cortical neuronal depolarization without the need for anesthesia or producing a generalized seizure. Typical courses are administered in an outpatient setting under an FDA-cleared device and trained clinician, with acute courses delivered up to 5 days per week for up to 6 weeks (commonly culminating in a taper schedule).

Definitions

inv-12: Acute (Index) Course of Treatment — definition.

DefinitionThe initial series of treatment given to relieve acute symptoms of Major Depressive Disorder (MDD).

PurposeRelieve acute depressive symptoms and achieve clinical improvement during the current episode.

ContextServes as the index course against which response and need for additional or repeat courses are evaluated.

inv-13: Adequate Trial — definition (taking drug ≥4 weeks at/near max dose or documentation of intolerance).

DefinitionTaking a drug at least 4 weeks at or near the FDA‑approved maximum dose for the specific medication, or documentation that higher doses were not tolerated when dose is less than the FDA‑approved maximum.

PurposeEstablishes adequate exposure to pharmacotherapy when determining treatment resistance prior to TMS.

Level of Care

Treatment Modalities

Visit Limits and Session Counts

inv-18: TMS treatment sessions — Up to 30 sessions (acute/index course limit).

Acute/index course limitUp to 30 sessions per acute/index course

Course periodDelivered over up to 6 weeks (maximum)

Session frequencyTypically up to 5 days per week

Policy Summary

PayerCareSource Georgia

PolicyTranscranial Magnetic Stimulation for Treatment of Depression

Policy CodePolicy Transcranial Magnetic Stimulation for Treatment of Depression-MP-MM-1339

Change TypeRevised medication trial requirement

Effective DateJun 1, 2026

Last ReviewJun 1, 2026

Next Review DateMar 11, 2026

Key ActionObtain prior authorization documenting age, diagnosis, two adequate antidepressant trials (or intolerance), psychotherapy trial, and absence of contraindications.

SourceLink

On This Page

Prior authorization must include documentation of trials of two antidepressant agents, including at least two different agent classes, each taken at or near the maximum effective dose and duration (unless not tolerated). Intolerance may be documented by two trials with distinct side effects.

At least two adequate antidepressant trials (distinct agents and at least two different classes) at or near maximum effective dose/duration.
If medications were not tolerated, document two antidepressant trials with distinct side effects to support intolerance.
This policy revised the medication trial requirement from four to two adequate trials.

Documentation Required

Required clinical documentation to support prior authorization

Include the following clinical documentation with the prior authorization: a confirmed diagnosis of major depressive disorder (single or recurrent) with a recent score on a standardized depression rating scale; documentation of at least two adequate antidepressant trials or documented intolerance; evidence of a 12‑week trial of evidence‑based psychotherapy without significant improvement; and prior TMS response records if applicable.

Recent standardized depression rating scale score demonstrating a current severe episode (eg, PHQ‑9, HAM‑D, BDI, QIDS, GDS).
Medical record evidence of two adequate antidepressant trials (or two trials documenting intolerance) including agent names, doses, durations, and response.
Documentation of a 12‑week trial of evidence‑based psychotherapy (alone or with medications) without significant improvement.
If applicable, objective evidence of prior TMS response (>50% improvement on a standardized scale).

Denial Risk

Common triggers for denial

Requests may be denied if any of these triggers are present: member is under 18 years of age; there is no documentation of two adequate antidepressant trials (including at least two different classes) or documented intolerance; absence of a recent standardized depression rating scale showing a current severe episode; lack of a 12‑week psychotherapy trial when required; or presence of contraindications (eg, seizure disorder, bipolar disorder, psychotic disorder, cochlear implant/deep brain stimulator).

Age <18 — member must be ≥18.
Missing documentation of two adequate antidepressant trials (or intolerance) with agent, dose, duration, and response.
No recent standardized depression rating scale score documenting current severe episode.
No documentation of a 12‑week trial of evidence‑based psychotherapy when indicated.
Documented contraindications such as epilepsy/history of seizure, bipolar disorder, acute/chronic psychotic symptoms, cochlear implants or deep brain stimulators.

Applied toAntidepressant agents used in trials required before authorization of TMS (two distinct agents/classes).

inv-14: Continuation TMS — definition (treatment after acute/index course up to 6 months to prevent worsening).

DefinitionTreatment beginning after the acute/index course lasting up to 6 months and designed to prevent worsening of symptoms or continued treatment for a depressive episode that has not yet remitted.

Distinguished from maintenanceContinuation TMS is time‑limited (up to 6 months) and aimed at preventing worsening of the current episode; routine maintenance (weekly/biweekly/monthly to prevent relapse) is not considered medically necessary.

Use caseProvided when ongoing symptom control is needed following an acute/index course but before remission is achieved.

inv-15: Remission — definition (absence of significant signs or symptoms of a major depressive episode during previous 2 months).

DefinitionThe absence of significant signs or symptoms of a major depressive episode during the previous 2 months.

AssessmentDetermined using standardized depression rating scales (e.g., PHQ‑9, HAM‑D, QIDS) documented in the record.

RelevanceUsed to evaluate treatment goals and decisions about discontinuing or repeating TMS courses.