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Anthem transcranial magnetic stimulation request form 2026

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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 for TMS eligibility. It includes sections to document medication trials, psychotherapy outcomes, and compliance with FDA stimulation parameters. The form must be completed and faxed for timely review.

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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 and contact information as well as the office manager's details.
In the section for outpatient practitioners, if applicable, list any additional psychiatrists or therapists involved in the member’s care along with their contact numbers.
Carefully check all relevant boxes that apply to the member’s condition and treatment history. This includes confirming diagnoses and previous treatment trials.
Document any current medications and their trial outcomes in the specified sections. Be thorough to support your request effectively.
Finally, review all entered information for completeness and accuracy before signing and submitting your form through our platform.

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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.

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