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Good news! Most health insurance plans cover TMS Therapy for depression, but some conditions must be met first. Each plan has its own requirements, some of the most common ones are described above. We suggest to call your health insurance provider and verify that you are qualified.
How do you qualify for TMS treatment?
To qualify for TMS therapy, patients must be over 18, diagnosed with major depressive disorder (MDD) or treatment-resistant depression (TRD) and: Have tried at least two different antidepressants from two classes (SSRIs, SNRIs, or MAOIs) without seeing results, OR.
What conditions is TMS approved for?
TMS has approval from the U.S. Food and Drug Administration (FDA) to treat four conditions: Major depressive disorder (MDD) (including treatment-resistant depression). Obsessive-compulsive disorder (OCD). Migraines. Smoking cessation.
Does TMS require prior authorization?
In the case of TMS therapy, a prior authorization is necessary to ensure that your insurance will cover the cost of treatment. There are a few different types of prior authorizations, and sometimes these might be called pre-authorizations, pre-certifications, and/or pre-determinations.
Is TMS therapy covered by Cigna?
Does Cigna Cover Transcranial Magnetic Stimulation (TMS therapy)? Yes. Cigna covers transcranial magnetic stimulation (TMS) as a part of its outpatient care policies, considering it a medically necessary procedure under certain conditions for treating major depressive disorder and Obessive Compulsive Disorder (OCD).
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There are certain restrictions on who can undergo TMS treatment. Not all individuals with depression are eligible. TMS treatment is not recommended for those who have a history of seizures or have metal implants or items around their heads.
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.
Related links
cigna-certificate-of-coverage.pdf - Michigan State University
YOU FILE CIGNAS CLAIM FORMS, OR WHEN YOU. CALL YOUR CIGNA CLAIM OFFICE Stimulation (TMS), etc. Calendar Year Maximum: Unlimited. Plan Deductible
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