Transcranial Magnetic Stimulation (for Ohio Only)
State-specific UnitedHealthcare medical policy (Ohio only) for Transcranial Magnetic Stimulation (TMS) covering adults 18+ with clinical coverage tied to InterQual Procedures: TMS and listing several indications considered unproven/not medically necessary for adults and children. Includes applicable CPT/HCPCS codes and extensive evidence review for multiple conditions.
Replaced instruction to 'refer to the InterQual CP: Procedures, Transcranial Magnetic Stimulation (TMS) for medical necessity clinical coverage criteria for chronic' with 'refer to the InterQual CP: Procedures, Transcranial Magnetic Stimulation (TMS) for medical necessity clinical coverage criteria'.
Removed 'transcranial magnetic stimulation (TMS) for treating epilepsy, Parkinson's disease, and tinnitus' from previously allowed services and listed them as unproven/not medically necessary.
Added language for Members Under 18 Years of Age indicating multiple conditions (including Alzheimer's disease, chronic neuropathic pain, dystonia, headaches, Parkinson's disease, stroke, tinnitus, TBI, nTMS for treatment planning/diagnosis, theta-burst protocols) are unproven and not medically necessary.
Updated instruction to refer to the Optum Behavioral Clinical Policies for behavioral disorders not addressed in InterQual criteria.
Archived previous policy version CS124OH.C
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