For referring providers
What insurers require before approving TMS.
Coverage criteria vary by plan and by diagnosis. The requirements below reflect what our payers currently look for. If you are unsure whether your patient meets them, refer anyway — our staff performs a verification of benefits before treatment begins.
Treatment-Refractory
Major Depressive Disorder
Insurances We Accept
- Cigna
- United Healthcare
- Tricare
- Medicare
- BCBS of TN
- VA Community Care for veterans
VA Community Care requires an authorization from the VA.
Requirements
- Documented ICD-10 code F33.2 — recurrent, severe major depressive disorder without psychosis — diagnosed by a psychiatrist or behavioral health provider. A PCP or other specialist cannot supply this diagnosis.
- Cigna will also accept F33.1 — major depressive disorder, recurrent, moderate.
- Documented history of a failed psychotherapy trial of adequate duration and sufficient length.
- At least two antidepressants tried, in two different medication classes.
- PHQ-9 score reflecting moderate to severe depression.
- Age: 15 years or older for Cigna and United Healthcare; 18 years or older for all other plans.
Treatment-Refractory
Obsessive Compulsive Disorder
Insurances We Accept
- Medicare
- Cigna
- Tricare
- VA Community Care for veterans
VA Community Care requires an authorization from the VA. For Cigna, the diagnosis may be any OCD diagnosis as defined by the DSM-5.
Requirements
- Documented ICD-10 codes
F42.2(mixed obsessional thoughts and acts)
F42.3(hoarding disorder)
F42.4(excoriation/skin picking disorder)
F42.8(other obsessive-compulsive disorder)
F42.9(obsessive-compulsive disorder, unspecified)
Must be diagnosed by a psychiatrist or behavioral health provider. A PCP or other non-mental health specialist cannot provide this diagnosis.
- Documented history of an adequate trial of an evidence-based psychotherapy known to be effective in treating OCD, without significant improvement in symptoms.
- Two or more psychopharmacologic drugs tried and failed for the treatment of OCD.
- Age: patient must be 18 years or older.
TMS for chronic pain, neuropathy, and fibromyalgia is not covered by insurance. These conditions are treated on a self-pay basis, and we offer self-pay packages and payment plans.
This information is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any condition. Services, insurance coverage, and treatment recommendations vary by individual, plan, diagnosis, and clinical evaluation. TMS may not be appropriate for every patient. Please consult a qualified healthcare provider to determine the best care plan for your specific needs.