CurrentUnitedHealthcarePolicy CS124NJ.L

Transcranial Magnetic Stimulation Nj Cs

UnitedHealthcare Community Plan medical policy (New Jersey only) addressing the use of transcranial magnetic stimulation (TMS), including navigated TMS and theta-burst stimulation, for non-behavioral/physical health conditions; lists services considered unproven/not medically necessary and provides applicable procedure codes and literature review summaries for multiple conditions (Alzheimer disease, epilepsy, headaches, Parkinson disease, etc.).

Policy Summary

PayerUnitedHealthcare

PolicyTranscranial Magnetic Stimulation Nj Cs

Policy CodePolicy CS124NJ.L

Change TypeRevised (title, supporting information, description, evidence, references)

Effective DateMar 1, 2026

Next Review Date

Key ActionPolicy applies only to New Jersey; providers must follow this New Jersey-specific policy when requesting coverage for TMS for non-behavioral conditions.

SourceLink

POLICY UPDATE CHANGES

Title changed from 'Transcranial Magnetic Stimulation (for New Jersey Only)' and supporting information, description of services, clinical evidence, and references were updated.

1State-specific policy (New Jersey only)

10+Non-covered medical indications listed

9Indications discussed

lowOverall evidence certainty

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multipleSystematic reviews / meta-analyses cited

1Policy version archived

Coverage Summary

Scope: This is a New Jersey–specific UnitedHealthcare Community Plan medical policy addressing the use of transcranial magnetic stimulation (TMS), including navigated TMS and theta-burst stimulation, for non-behavioral/physical health conditions. Policy number: CS124NJ.L. Effective date: March 1, 2026.

Stance: TMS for non-behavioral/medical conditions is designated unproven and not medically necessary due to insufficient evidence of efficacy. The policy lists >10 example medical indications that are not covered (including Alzheimer disease, chronic neuropathic pain, dystonia, epilepsy, headaches, Parkinson disease, stroke, tinnitus, and traumatic brain injury) and specifies that the policy applies only in New Jersey; providers should follow this state-specific policy when requesting coverage for these indications.

Key thresholds & quick facts

Thresholds - total stimulation pulses18,000 to 20,000 total stimulation pulses (PD subgroup analyses associated with larger motor effects)

Thresholds - MCID (pain)MCID for pain: 15% reduction or ≥1.5 points on 0–10 NRS/THI; many pooled effects fall below this threshold

Stats - state applicabilityPolicy applies only to New Jersey (state-specific)

Stats - policy version archivedPrevious policy version CS124NJ.K archived

Scope summaryUnitedHealthcare Community Plan NJ policy on TMS (including navigated TMS and theta-burst) for non-behavioral/physical health conditions; lists services considered unproven/not medically necessary and cites supporting evidence and procedure codes

Not Medically Necessary / Unproven Indications

The following uses an AND (all) operator: any transcranial magnetic stimulation application for non-behavioral medical conditions is considered not medically necessary or unproven.

ALL of the following

Transcranial magnetic stimulation for treating all medical (i.e., non-behavioral) conditions (not medically necessary / unproven). Examples include but are not limited to: Alzheimer disease, chronic neuropathic pain, dystonia, epilepsy, headaches, Parkinson disease, stroke, tinnitus, traumatic brain injury.
Navigated transcranial magnetic stimulation for treatment planning or for diagnosing motor neuron diseases or neurological disorders (not medically necessary / unproven).
Theta-burst stimulation, including accelerated and/or magnetic resonance imaging-guided protocols (not medically necessary / unproven).

Evidence Summaries by Indication

Evidence summaries by indication

Summaries of clinical evidence and conclusions for various indications:

Parkinson disease

Subgroup analyses suggest HF-rTMS targeting M1 (including bilateral M1) and multisession protocols with higher total pulses (18,000–20,000) may yield larger motor improvements; LF-rTMS not significant.

Pain / Neuropathic pain / Chronic pain / Fibromyalgia

rTMS may predict response to epidural motor cortex stimulation (specificity 60–100%, PPV 75–100%) and could be used for selection for implantation, but long-term effects on quality of life and medication use are unclear.
Some RCTs reported safety (no serious adverse events) but were limited by small sample sizes and short follow-up.

Coding

Referenced Procedure Codes (listed for reference only)CPT

0858T	Externally applied transcranial magnetic stimulation with concomitant measurement of evoked cortical potentials with automated report.
0889T	Personalized target development for accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation...
0890T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, initial treatment day.
0891T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, subsequent treatment day.
0892T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, subsequent motor threshold redetermination per treatment day.
90867	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.
90868	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session.
90869	Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management.

FDA Product Codes referenced (informational)mixed

GWF	FDA product code referenced for TMS devices
HAW	FDA product code referenced for TMS devices
IKN	FDA product code referenced for TMS devices
OBP	FDA product code referenced for TMS devices
OCI	FDA product code referenced for TMS devices
OKP	FDA product code referenced for TMS devices

Provider Actions & Requirements

Prior Authorization

Prior Authorization / Coverage Expectation

TMS for the listed non‑behavioral/medical indications is not covered in New Jersey; providers should expect denials and must verify benefits or contractual exceptions prior to service.

0858T
0889T
0890T
0891T
0892T
90867
90868
90869

Documentation Required

State Applicability

This policy applies only to the state of New Jersey. Providers must follow the New Jersey‑specific policy when requesting coverage for TMS for non‑behavioral conditions.

Definitions

HF-rTMSHigh-frequency repetitive transcranial magnetic stimulation — typical frequencies 5–20 Hz

LF-rTMSLow-frequency repetitive transcranial magnetic stimulation — typically 1 Hz

nTMSNavigated transcranial magnetic stimulation — neuronavigated TMS used for preoperative cortical mapping and diagnostic stimulation at precise anatomical locations

TBSTheta-burst stimulation — patterned form of TMS (continuous and intermittent protocols), short bursts of 3–5 pulses with specific interburst timing; includes accelerated and MRI-guided variants under investigation

Revision History

2026-03-01effectiveLatest

Policy effective date: CS124NJ.L became effective March 1, 2026.

2026-03-01revised

Archived previous policy version CS124NJ.K; title changed from 'Transcranial Magnetic Stimulation (for New Jersey Only)'; supporting information, description of services, clinical evidence, and references were updated.

Policy Summary

PayerUnitedHealthcare

PolicyTranscranial Magnetic Stimulation Nj Cs

Policy CodePolicy CS124NJ.L

Change TypeRevised (title, supporting information, description, evidence, references)

Effective DateMar 1, 2026

Next Review Date

Key ActionPolicy applies only to New Jersey; providers must follow this New Jersey-specific policy when requesting coverage for TMS for non-behavioral conditions.

SourceLink

On This Page

Not Medically Necessary / Unproven Indications

Denial Risk

Coverage Expectation / Denial Risk

Transcranial magnetic stimulation for the medical (non‑behavioral) indications listed above is considered not medically necessary / investigational in New Jersey. Prior authorization is expected and denial is likely if used for these non‑behavioral indications. Providers should ensure members (or their legal representatives) are informed about the evidence limitations and obtain documented informed consent that explains the investigational nature of TMS for these conditions.

Affected codes (NJ-specific): 0858T, 0889T, 0890T, 0891T, 0892T, 90867, 90868, 90869
Prior Authorization / Coverage Expectation applies — submit PA per UnitedHealthcare Community Plan New Jersey requirements
Evidence-based limitation: insufficient high-quality evidence of efficacy for listed non‑behavioral indications; therapy considered investigational/not medically necessary
Informed consent: document that patient was counseled on experimental/unproven status, alternatives, potential risks and benefits, and uncertainties

Pooled NIBS analyses after SCI found no significant effect on pain; CES showed possible anxiety benefit.

Stroke / Motor recovery / Spasticity / Spatial neglect / Poststroke neurogenic bladder

An RCT reported LF-rTMS improved poststroke neurogenic bladder vs sham with good tolerability; single-center and small sample limitations.
Theta-burst stimulation may improve unilateral spatial neglect but evidence limited.

Tinnitus: Meta-analyses indicate rTMS can improve tinnitus-related symptoms (THI scores) at short- and longer-term follow-ups (up to 6 months) with some mean differences meeting thresholds in pooled analyses; heterogeneity and variable study quality noted; AAO-HNS guideline advises clinicians should not recommend TMS for persistent bothersome tinnitus.

Traumatic brain injury (TBI): A small RCT in chronic diffuse axonal injury (n=30) found no difference between rTMS and sham on cognitive outcomes; no safety differences; limitations include small size and heterogeneity.

Navigated Transcranial Magnetic Stimulation (nTMS) - preoperative mapping: Evidence supports nTMS as a functional preoperative motor and language mapping adjunct: distances between nTMS and DCS mapping vary; pooled observational data show nTMS motor mapping associated with reduced risk of new permanent motor deficits (OR 0.54) and higher gross total resection rates (OR 2.32), reduced craniotomy size; however, high-level RCT evidence lacking and standardized protocols needed.

Theta-burst stimulation (accelerated / MRI-guided): Studies demonstrating clinical use and safety of accelerated, repetitive, MRI-guided theta-burst stimulation are lacking; cannot conclude benefit. Small RCTs of TBS in other disorders reported inconclusive results due to small size and heterogeneity.

Professional society guidance: Guidelines: AAN: rTMS possibly effective for primary moderate to severe restless legs syndrome (level C) and insufficient evidence for tics/Tourette; AAO-HNS (2014): clinicians should not recommend TMS for persistent bothersome tinnitus; EAN: weak recommendation for M1 rTMS in neuropathic pain and fibromyalgia; inconclusive for other targets.

Brief evidence highlights

Parkinson diseaseModest positive effects on motor outcomes; pooled effect sizes ~0.4–0.6 (modest); subgroup benefit for HF-rTMS over M1

Parkinson disease effect size (numeric)Effect sizes ~0.4–0.6 reported in meta-analyses

Chronic pain - short-term pooled effectShort-term pooled effect ~0.40-point reduction on 0–10 pain scale (~7% reduction), below MCID

Neuropathic pain (SCI) pooled resultMD −0.81 (95% CI −1.45 to −0.17) favoring rTMS (Saleh 2022)

nTMS motor mapping pooled outcomePooled OR 0.54 (p=0.001) for reduced risk of new permanent motor deficits favoring nTMS mapping (Raffa 2019)

Notable trial - Rymaszewska et al. (2025)Small RCT of TBS in treatment‑resistant OCD (n=32 eligible, 27 completed initial phase); active group showed improvements but conclusions limited by small size and dropout

Notable trial - Chen et al. (2022) TBS in MCIDiffusion MRI‑guided TBS improved associative memory and hippocampal connectivity; iTBS appeared more effective than cTBS or sham; limited by small sample

Background: TMS technologies include single-pulse TMS (used to explore brain function), repetitive TMS (rTMS) (used to induce lasting changes in brain activity), navigated TMS (nTMS) for precise functional mapping, and theta-burst stimulation (TBS) (patterned short bursts such as intermittent or continuous TBS and accelerated MRI-guided TBS). The evidence base across non-behavioral/medical indications is heterogeneous and limited: studies frequently have small sample sizes, use variable stimulation protocols and outcome measures, and report only short-term follow-up

Documentation Required
Evidence-based limitations and informed consent
Document that indications for rTMS have heterogeneous evidence, that benefits are often modest and/or transient, and that protocols and long‑term outcomes are limited when considering off‑label or experimental use; include discussion as part of informed consent.

Prior Authorization
Case selection for motor cortex stimulation referral
When considering referral for epidural motor cortex stimulation, consider using rTMS response testing to help predict suitability and document rTMS response testing results in the record.

Note
FDA device information (informational)
For device clearance/approval details, consult the FDA PMN and PMA databases (product codes referenced in policy). Note: FDA approval alone is not a basis for coverage under this policy.

Documentation Required
Policy applicability check
Before applying this policy, check applicable federal, state, or contractual benefit requirements as they may differ and govern in the event of a conflict.