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Anthem transcranial magnetic stimulation request form 2025

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The document is a request form for Transcranial Magnetic Stimulation (TMS) treatment, requiring detailed patient and physician information, diagnosis confirmation, prior treatment history, and specific criteria to justify the TMS request. It includes sections for medication trials, psychotherapy outcomes, and compliance with FDA guidelines for TMS administration.

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Click ‘Get Form’ to open the anthem transcranial magnetic stimulation request form in the editor.
Begin by filling in the member's personal information, including their name, ID number, date of birth, age, address, and contact number. Ensure accuracy for timely processing.
Next, provide details about the requesting TMS office. Include the physician's name, phone number, office manager's name, and their contact information.
If applicable, enter information for outpatient practitioners such as psychiatrists and therapists. Fill in their names and phone numbers.
Check all relevant boxes regarding the patient's condition and treatment history. This includes confirming diagnoses and previous treatment trials.
List all current diagnoses using ICD-10 codes and detail medication trials along with outcomes for both antidepressants and augmentation therapies.
Finally, review all entered information for completeness before signing off on the form to confirm its accuracy.

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How do you get approved for TMS therapy?

These include: No suicidal ideation. No psychotic symptoms. No metal in the cranium. No neurological conditions (seizures). Not pregnant or nursing. No substance abuse.

What diagnosis is TMS approved for?

Transcranial Magnetic Stimulation (TMS) is FDA approved for the treatment of depression and obsessive-compulsive disorders.

How do I get approved for TMS?

The patient must have a DSM diagnosis of F33. 2 (Recurrent Depressive Disorder, Current Episode Severe Without Psychotic Symptoms) or F32. 2 (Severe Depressive Episode Without Psychotic Symptoms). The severity of depression required, as measured by a clinical rating scale, differs by insurance plan.

How long does it take insurance to approve TMS therapy?

Most insurance companies that are in-network will only take five to seven business days to approve the procedure. In rare cases, it can take up to fifteen days. If a patient has out-of-network coverage, then a TMS provider may offer whats called a single case agreement with the insurance company.

How much does TMS device cost?

Initially introduced to the public in 2008, TMS treatment was extremely costly, with only one available device (NeuroStar) that medical practitioners could obtain at a high cost, resulting in high treatment prices. Many doctors using this device would bill upwards of $16,000 for a complete treatment regimen.

Who is not eligible for TMS?

There are people who cannot be treated with TMS. Patients with any metal implants are not eligible for this treatment. Those with bullet fragments near the head cannot have transcranial magnetic stimulation either. People who have had seizures in the past or are at high risk of having seizures must avoid TMS as well.

Who orders TMS?

In the US, for example, privileges to prescribe Deep TMS vary by state. While psychiatrists can universally offer Deep TMS treatment, many states allow other physicians, as well as nurse practitioners, physicians assistants, and prescribing clinical psychologists to do so, too.

What disqualifies you from TMS?

Due to the nature and effects of magnetic energy, patients with some forms of implant should avoid TMS therapy. This includes patients with implants that work with physiological signals such as pacemakers, vagus nerve stimulators (VNS), and implantable cardioverter defibrillators (ICDs).

Anthem transcranial magnetic stimulation request form 2025

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