July 2020 newsletter
Feature Articles
Transcranial Magnetic Stimulation (TMS) coverage policy update
To clarify our coverage position for transcranial magnetic stimulation (TMS), Cigna updated its policy, effective July 1, 2020, to include detailed language about an individual’s current episode of depression and antidepressant medication trials.
If you are a provider who renders TMS services, please review coverage policy information below to ensure that your patients with Cigna coverage meet the criteria. The revised language appears in italics.
Prior to rendering services, verify a patient’s eligibility and benefits by calling the number on the back of their ID card.
Coverage policy update
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:
- failure of two or more trials of antidepressant medications from two separate classes of antidepressant medications. A failed trial is defined as:
- use of an antidepressant medication, at adequate therapeutic doses for at least four weeks with no significant reduction in depressive symptoms
- use of an antidepressant medication with documented intolerance/medical contraindication
- 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
To access the complete TMS policy, visit the Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Coverage Policies > Medical and Administrative A-Z Index > Transcranial Magnetic Stimulation - (0383).
Request prior authorization for TMS
To request prior authorization for TMS, complete the Transcranial Magnetic Stimulation (TMS) Request Form, which is available at CignaforHCP.com > Resources > Forms Center > Behavioral Health Forms.
Please note: This form should be completed by the clinician who has a thorough knowledge of the patient’s current clinical presentation and his/her treatment history.
If you are a participating provider in Massachusetts, please call Cigna at 877.878.6980 to request authorization as some state-specific guidelines may apply.