ModifiedUnitedHealthcarePolicy CS124.P

Transcranial Magnetic Stimulation for Treating Physical Health Conditions

This policy governs UnitedHealthcare coverage stance and clinical rationale for using transcranial magnetic stimulation (TMS) to treat physical/neurological medical conditions (not behavioral health). It applies nationally except where state‑specific TMS policies are named.

Policy Summary

PayerUnitedHealthcare

PolicyTranscranial Magnetic Stimulation for Treating Physical Health Conditions

Policy CodePolicy CS124.P

Change TypeUpdated clinical evidence, description of services, and referencestitle refined (archived prior version CS124.O).

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionWhen requesting coverage, document the clinical indication and whether treatment is part of a registered clinical trial or performed under special governance/consent arrangements.

SourceLink

POLICY UPDATE CHANGES

Updated Description of Services, Clinical Evidence, and References sections to reflect the most current information.

Policy title changed from 'Transcranial Magnetic Stimulation' to 'Transcranial Magnetic Stimulation for Treating Physical Health Conditions'.

Archived previous policy version CS124.O.

9+Unproven conditions listed

8 codesProcedure codes referenced

29 RCTsTinnitus RCTs pooled

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Alzheimer review trials

insufficientnTMS evidence strength

1Policy version archived

Coverage Criteria and Evidence Summary

Denial Risk

Provider Action / Billing and Denial Risk

Provider action / denial risk highlights: - Prior authorization and documentation: Prior authorization is likely required for TMS when billed for nonbehavioral medical indications; ensure documentation includes indication, relevant prior treatments, and rationale for use or research participation. - Denial risk: Requests for TMS for the listed nonbehavioral conditions (Alzheimer disease, chronic neuropathic pain, dystonia, epilepsy, headaches/migraine prevention, Parkinson disease, stroke rehabilitation, tinnitus, TBI cognitive impairment) are at high risk for denial given insufficient evidence of efficacy and guideline recommendations restricting routine use. - Research-only arrangements: For indications where NICE or other bodies recommend use only in research or with special arrangements (e.g., Alzheimer disease, migraine prevention), coverage — if considered — should be limited to participation in approved clinical trials or programs with clinical governance and audit. - Billing/coding: When submitting claims for nTMS motor mapping in brain tumor surgical planning, include supporting clinical documentation; given observational evidence of benefit but absence of RCTs, coverage determinations may vary and investigative status may apply.

Affected conditions: Alzheimer disease; chronic neuropathic pain; dystonia; epilepsy; headaches/migraine prevention; Parkinson disease; stroke; tinnitus; traumatic brain injury.
State policy exceptions: See Application block for state‑specific policies that may differ.

TMS Modalities and Definitions

inv-47: TMS (rTMS, theta‑burst, navigated TMS)

Modalities described: rTMS, theta‑burst stimulation (including accelerated protocols), deep TMS, and navigated neuronavigation‑guided TMS are described as investigational or under study for various physical/neurological conditions

Behavioral TMS covered in a separate policy; this policy focuses on non‑behavioral conditions.

inv-48: TMS / rTMS

rTMS for Parkinson motor symptoms: Meta-analyses report short-term and some longer-term motor improvements with HF-rTMS targeting M1 (bilateral or multisession protocols and higher total pulses often associated with larger effects), but optimal parameters remain unclear and larger trials are needed.

See Yang et al. 2018; Deng et al. 2022; Romero et al. 2024

rTMS for neuropathic pain: Systematic reviews and RCTs indicate HF-rTMS over M1 or left DLPFC may reduce neuropathic pain intensity and pain-related disability in some studies, with modest and often transient effect sizes.

Provider Requirements, Prior Authorization, and Documentation

Billing Rule

Procedure codes referenced — prior authorization implication

Include the applicable CPT codes listed in the policy when evaluating prior authorization and claims (0858T; 0889T–0892T; 90867–90869); listing is for reference and does not guarantee coverage—use codes for authorization and billing checks per member plan.

Use CPT codes 0858T, 0889T–0892T, 90867–90869 when submitting PA requests or claims related to TMS services.
Inclusion of a code in the policy does not imply coverage—benefit depends on the member's plan and applicable laws.

Prior Authorization

Prior auth: trial or governance evidence

When prior authorization is requested for TMS in indications with NICE/research restrictions (e.g., Alzheimer disease, migraine), request documentation stating whether treatment is part of a registered clinical trial or performed under special governance/consent/audit arrangements.

Procedure and Product Codes

Applicable CPT and HCPCS CodesCPT

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 including data preparation, generation of target, motor threshold-starting location, neuronavigation files and target report, review and interpretation
0890T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including target assessment, initial motor threshold determination, neuronavigation, delivery and management, initial treatment day
0891T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent treatment day
0892T	Accelerated, repetitive high-dose functional connectivity MRI-guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent motor threshold redetermination with delivery and management, 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 Device Product Codes (informational)mixed

GWF	FDA product code for certain TMS devices (refer to FDA database for device-specific details)
HAW	FDA product code for certain TMS devices (refer to FDA database for device-specific details)
IKN	FDA product code for certain TMS devices (refer to FDA database for device-specific details)
OBP	FDA product code for certain TMS devices (refer to FDA database for device-specific details)
OCI	FDA product code for certain TMS devices (refer to FDA database for device-specific details)
OKP	FDA product code for certain TMS devices (refer to FDA database for device-specific details)

Definitions and Background

Transcranial magnetic stimulation (TMS) is a noninvasive technique that induces electrical currents in the brain using brief magnetic pulses. Single‑pulse TMS is used diagnostically and for cortical mapping, while repetitive TMS (rTMS), including patterned forms such as theta‑burst stimulation, is investigated to modulate cortical excitability and produce longer‑lasting clinical effects.

rTMS / Theta‑burst / Navigated TMS — definitions

rTMS (repetitive TMS)Repetitive trains of magnetic pulses delivered to the cortex to induce changes in brain activity that persist beyond stimulation; used investigationally for multiple neurological conditions and to modulate cortical excitability.

Theta‑burst stimulation (TBS)A patterned form of rTMS in which short bursts (typically 3–5 pulses) are delivered at high intraburst frequency with a theta‑frequency interburst interval; includes intermittent (iTBS) and continuous (cTBS) protocols and accelerated variants.

Navigated TMS (nTMS)TMS combined with neuronavigation to precisely target anatomical cortical locations for functional mapping and treatment planning; under investigation for preoperative motor and language mapping.

Policy Summary

PayerUnitedHealthcare

PolicyTranscranial Magnetic Stimulation for Treating Physical Health Conditions

Policy CodePolicy CS124.P

Change TypeUpdated clinical evidence, description of services, and referencestitle refined (archived prior version CS124.O).

Effective DateMar 1, 2026

Next Review DateN/A

Key ActionWhen requesting coverage, document the clinical indication and whether treatment is part of a registered clinical trial or performed under special governance/consent arrangements.

SourceLink

On This Page

See Gatzinsky 2020; Saleh 2022; Yang 2022

inv-49: TMS

rTMS for neuropathic pain (trial findings): Trials show potential short-term analgesia for neuropathic pain when targeting M1 or DLPFC (some meta-analyses report significant SMDs), but heterogeneity and small sample sizes limit certainty; document diagnosis, prior treatments, and stimulation parameters when requesting coverage.

Yang 2022; Che 2021; Saleh 2022

inv-50: Theta-burst stimulation (TBS)

Theta-burst stimulation (TBS): Evidence for accelerated and MRI-guided TBS is lacking; small pilot RCTs report preliminary signals for memory in MCI and inconclusive results for OCD, but overall data are insufficient for routine clinical coverage.small sample sizes, methodological limitations

Chen et al. 2022; Rymaszewska et al. 2025

inv-51: Repetitive transcranial magnetic stimulation (rTMS)

rTMS for TBI cognitive deficits: Randomized trial evidence did not demonstrate cognitive improvement with rTMS in chronic diffuse axonal injury; consider investigational/not covered for TBI cognitive deficits absent stronger evidence.single RCT with negative results

Neville et al. 2019

inv-52: TMS/rTMS

References and modalities overview: References include recent RCTs and meta-analyses of rTMS for neuropathic pain, migraine, tinnitus, cognitive impairment/Alzheimer disease, Parkinson disease, and stroke; modalities described include rTMS, theta-burst, accelerated protocols, deep TMS, and navigated TMS.

See References section for full citations.

Require explicit statement of trial enrollment or description of governance/audit arrangements in PA submission.
If absent, note that NICE-based guidance supports restricting routine coverage to research/special arrangements.

Prior Authorization

Prior authorization recommended for tinnitus and pain indications

Consider requiring prior authorization for rTMS when requested for chronic tinnitus or chronic pain to ensure appropriate indication, protocol, and supporting evidence are provided given mixed and limited evidence.

PA can verify indication, prior conservative treatments, stimulation target and protocol, and evidence supporting clinical benefit.
PA helps reconcile conflicting guideline recommendations and meta-analytic findings.

Prior Authorization

Prior authorization for nTMS mapping

For navigated TMS (nTMS) used for preoperative motor or language mapping, require documentation of brain tumor diagnosis, planned surgery, and how mapping results will inform surgical approach to support coverage decisions.

Include tumor diagnosis, planned resection details, and mapping results demonstrating impact on surgical planning in the PA record.
Evidence shows nTMS mapping is associated with reduced postoperative permanent motor deficits and increased gross total resection but higher‑level RCTs are still needed.

Note

Coverage subject to plan terms

Refer to the member's federal, state, or contractual benefit plan to determine whether TMS services require prior authorization or are covered; this policy is informational and contractual terms govern in case of conflict.

Check member-specific plan terms and applicable federal/state requirements before approving coverage.
In event of conflict, federal/state/contractual requirements govern coverage decisions.

Note

Step therapy / guideline references

The policy references Optum guideline content (navigated TMS, theta‑burst, accelerated protocols) that may influence local guideline or step‑therapy implementation, but concrete step‑therapy rules are not specified in this policy.

Local implementation may translate guideline content into step requirements; this policy does not itself impose step‑therapy prerequisites.
Coordinate with behavioral/clinical policy content where applicable.

Prior Authorization

Step requirements for epilepsy

For epilepsy, given inconsistent efficacy and low‑certainty evidence for seizure reduction, prior authorization may require documentation of prior standard therapies tried and rationale for TMS as an investigational adjunct.

Document previous antiepileptic medications and other standard treatments attempted and the clinical rationale for considering TMS.
Note low to very low certainty evidence and variable trial results when adjudicating PA.

Documentation Required

Conservative therapy documentation

Before authorizing rTMS for chronic pain, document prior conservative therapies and optimized medical management (e.g., pharmacologic therapy, physical therapy) given variable and generally modest effects reported in the literature.

Include details of conservative treatments attempted, duration, and response in the PA record.
Motivate rTMS as a next option only after reasonable conservative management has been optimized.

Step Therapy

Step therapy — theta-burst

No specific step therapy requirements are described for theta‑burst or accelerated protocols in this policy; evidence for accelerated/MRI‑guided theta‑burst is lacking and routine step rules are not provided.

Do not assume established step‑therapy pathways for theta‑burst—policy notes insufficient evidence for accelerated/MRI‑guided protocols.
If a payer adopts local step rules, they should be informed by evolving evidence.

Billing Rule

Coding and benefit documentation

Listing of procedure codes in this policy is for reference only; inclusion does not guarantee coverage or reimbursement—benefit determination depends on the member's specific plan and applicable laws.

Use the listed CPT codes when preparing documentation, but confirm coverage with the member's benefit plan.
The policy's code list does not itself confer coverage rights.

Documentation Required

Evidence of research/special arrangements

When TMS is being requested under claimed research or special arrangements (e.g., NICE‑recommended RCTs or governance), include indication‑specific supporting evidence such as trial enrollment documentation or description of governance/consent/audit arrangements in the prior authorization submission.

Attach trial registry ID, consent forms, or governance/audit documentation when applicable.
Without such evidence, requests for indications restricted to research may be denied.

Documentation Required

Functional outcome documentation for stroke

When rTMS is used for poststroke motor recovery, document baseline and post‑treatment functional outcome measures (for example, Fugl‑Meyer Assessment, hand motor function tests) as trials reported these measures to assess benefit.

Include baseline and follow‑up Fugl‑Meyer Assessment scores and other motor function test results in the clinical record and PA documentation.
Outcome measures support medical necessity determinations for poststroke rTMS.

Documentation Required

nTMS mapping documentation

For nTMS mapping requests, include the indication (brain tumor location), mapping results, and a clear statement of how mapping informed surgical planning to support authorization and coverage decisions.

Provide imaging/operative plans showing how nTMS findings changed the surgical approach or resection strategy.
Include documentation that nTMS mapping will influence extent of resection or intraoperative monitoring plans.

Note

Pre-use contract check

Check federal, state, and contractual plan requirements and any third‑party tools UnitedHealthcare may use (for example, InterQual) before applying this policy to patient care or coverage decisions.

Confirm whether a state‑specific TMS policy supersedes this national policy.
Use third‑party criteria only as authorized and reconcile them with contractual terms.

Note

Contractual/Regulatory Conflict Risk

Coverage decisions must reference federal, state, or contractual requirements for benefit plan coverage; where those requirements conflict with this policy, the federal/state/contractual terms govern and may necessitate coverage despite the policy’s unproven stance.

In case of conflict between this policy and plan/federal/state rules, the plan/federal/state requirements prevail.
Failure to follow contractual/regulatory requirements may result in denial or inappropriate approval.

HF‑rTMS / LF‑rTMS — definitions

High‑frequency rTMS (HF‑rTMS)Stimulation paradigms using pulse frequencies typically >=5 Hz; HF protocols are often associated with excitatory effects and have been used to target motor and prefrontal cortex in trials reporting short‑term motor or analgesic benefits.

Low‑frequency rTMS (LF‑rTMS)Stimulation paradigms using pulse frequencies typically around 1 Hz (lower than HF); LF protocols are generally associated with inhibitory effects and have been evaluated in some poststroke and other applications.

Clinical implicationChoice of HF vs LF influences physiological effect (excitatory vs inhibitory) and is selected based on target and desired clinical outcome (e.g., HF favored for PD motor improvements).

Target sites — common cortical targets and implications

Primary motor cortex (M1)Common target for neuromodulation in neuropathic and chronic pain studies and for motor recovery after stroke or in Parkinson disease; M1 targeting is associated with analgesic and motor effects in multiple trials.

Dorsolateral prefrontal cortex (DLPFC)Frequently targeted in pain and mood‑related protocols (often left DLPFC for HF stimulation); DLPFC stimulation has produced short‑term analgesia in some chronic pain studies and is used in mood disorder protocols elsewhere.

Implications of target selectionTarget selection influences expected outcome domain (e.g., M1 for pain/motor, DLPFC for mood/analgesia) and may require different stimulation parameters, session counts, and navigation techniques.

HF‑rTMS — high‑frequency definition

Definition (frequency threshold)High‑frequency rTMS refers to stimulation at frequencies typically >=5 Hz, used to produce excitatory effects on targeted cortex.

Common usesHF‑rTMS has been used over M1 for motor and pain outcomes and over left DLPFC in analgesia and mood studies; some meta‑analyses report short‑term motor improvements with HF‑rTMS in Parkinson disease.

Dose considerationsTrials have varied in total pulses and sessions (e.g., PF 18,000–20,000 total pulses in PD studies) and higher total pulses/multisession protocols may yield larger effects in some indications.

NIBS — umbrella term

DefinitionNoninvasive brain stimulation (NIBS) is an umbrella term for brain‑directed, noninvasive neuromodulation techniques including rTMS, transcranial direct current stimulation (tDCS), and cranial electrotherapy stimulation (CES).

ScopeNIBS techniques have been evaluated across pain, neuropathic conditions, mood, and cognitive impairment, but evidence quality and efficacy vary by modality and indication.

Clinical relevancePolicy discussions of rTMS are situated within the broader NIBS literature when considering comparative effectiveness and pooled meta‑analyses that include multiple modalities.

nTMS — definition and preoperative mapping use

Definition and methodNavigated transcranial magnetic stimulation (nTMS) pairs TMS with neuronavigation to localize cortical motor and language function at precise anatomical locations, aiding preoperative mapping and surgical planning.

Evidence summaryObservational systematic reviews report associations between nTMS motor mapping and reduced postoperative motor deficits and increased gross total resection, but RCT evidence is lacking and larger trials are needed.

Use casenTMS is used diagnostically to map functionally essential motor areas and to inform individualized surgical strategies rather than as a therapeutic neuromodulation per se.

Theta‑burst stimulation (TBS) — definition and variants

DefinitionTheta‑burst stimulation (TBS) is a patterned rTMS protocol delivering brief bursts of high‑frequency pulses repeated at a theta (≈5 Hz) interburst interval; includes continuous (cTBS) and intermittent (iTBS) forms.

Variants and accelerated protocolsAccelerated and MRI‑guided or connectivity‑guided TBS protocols are under investigation (including accelerated high‑dose, MRI‑guided intermittent TBS), but clinical safety and efficacy data are currently insufficient to support routine use.

Clinical statusSmall RCTs and pilot studies report preliminary signals in conditions such as MCI, OCD, and treatment‑resistant depression, but results are inconclusive and require larger, well‑designed trials.

rTMS/TMS — brief definition

rTMS / TMSRepetitive transcranial magnetic stimulation (rTMS or TMS) is a noninvasive technique delivering repeated magnetic pulses to modulate cortical activity and induce longer‑lasting changes in brain function; used diagnostically for mapping and investigationally for multiple therapeutic indications.

Delivery considerationsProtocols vary by frequency, target site, pulse number, session count, and use of neuronavigation; device types and parameters influence study heterogeneity.

SafetyTMS induces small electrical currents without need for anesthesia; safety profiles in trials are generally acceptable though rare seizure risk exists and depends on protocol and patient factors.