TMS CIGNA

Cigna Transcranial Magnetic Stimulation Therapy Coverage Policy

Does Cigna cover TMS therapy? Cigna covers TMS therapy with the following criteria:

Below are the details of Cigna’s TMS therapy coverage policy in 2020

An initial regimen (i.e. 30-36 treatments) of transcranial magnetic stimulation administered in an outpatient office setting using a U.S. Food and Drug Administration (FDA) approved device is considered medically necessary when an individual meets ALL of the following criteria:

• Age 18 years or older.

• Diagnosis of major depressive disorder (unipolar), moderate-to-severe, single or recurrent episode or acute relapse, without psychosis, as defined by the most recent edition of Diagnostic and Statistical Manual of Mental Disorders.

During the current episode of depression ALL of the following criteria are met:

• A total of at least two trials of antidepressant medications, at adequate therapeutic doses, from at least two different classes of antidepressant medications for at least four weeks and/or documentation that the individual has been unable to complete an adequate medication trial due to intolerance of or medical contraindication to a particular medication or class of medication.

• No significant reduction in depressive symptoms following pharmacotherapy.

• Had an adequate trial of an evidence-based psychotherapy known to be effective in the treatment of major depressive disorder, without significant improvement in depressive symptoms.

• Validated depression monitoring scales are administered at the beginning and at the end of the initial and each subsequent course of TMS.

Repeat transcranial magnetic stimulation (TMS) (i.e. 30-36 treatments) administered in an outpatient office setting for a recurrence or an acute relapse of major depressive disorder is considered medically necessary when ALL of the following criteria are met:

• All of the above criteria for initial TMS therapy were met prior to the initial course of TMS.
• Individual had more than a 50% improvement as evidenced by one or more standard rating scales for depression.
• Improvement has been maintained for at least two months after initial course of TMS.