Transcranial Magnetic Stimulation (for Louisiana Only)
UnitedHealthcare medical policy (Louisiana only) describing coverage stance, investigational/ unproven uses, applicable CPT codes, descriptions, and clinical evidence summaries for TMS/nTMS/theta-burst stimulation across neurologic and neuropsychiatric conditions. This is Part 1 of 3 and includes scope, listed unproven indications, codes referenced, descriptions of services, and evidence summaries for Alzheimer disease, epilepsy, headaches, and Parkinson disease.
Revised list of unproven and not medically necessary services to add TMS for TBI and theta-burst stimulation including accelerated and/or MRI-guided protocols.
Added CPT codes 0889T, 0890T, 0891T, and 0892T to Applicable Codes.
Removed CPT code 64999 from Applicable Codes.
Added notation that CPT codes 0889T-0892T are not on the State of Louisiana Medicaid Fee Schedule and therefore may not be covered by Louisiana Medicaid Program.
Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information.
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