Aetna · Clinical coverage policy

Aetna Transcranial Magnetic Stimulation (TMS) coverage criteria

Aetna covers transcranial magnetic stimulation (TMS) only for severe major depressive disorder (without psychosis) in members age 15 or older, using an FDA-cleared device, after the member has failed adequate trials of two antidepressants from different classes plus augmentation therapy and has no contraindications; treatment is capped at 30 sessions plus up to 6 tapering sessions, with retreatment allowed only after a documented 50% response sustained 2+ months. TMS for essentially all other neurologic/psychiatric conditions, newer protocols (accelerated TMS, SAINT, MeRT, MRI-guided/navigated TMS, ketamine adjunct, maintenance), and cranial electrical stimulation for any indication are considered experimental/investigational and not covered.

Policy CPB 0469 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0469

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0469 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Transcranial Magnetic Stimulation (TMS) (CPT 90867), and what gets it denied?

Path
Aetna covers transcranial magnetic stimulation (TMS) only for severe major depressive disorder (without psychosis) in members age 15 or older, using an FDA-cleared device, after the member has failed adequate trials of two antidepressants from different classes plus augmentation therapy and has no contraindications; treatment is capped at 30 sessions plus up to 6 tapering sessions, with retreatment allowed only after a documented 50% response sustained 2+ months. TMS for essentially all other neurologic/psychiatric conditions, newer protocols (accelerated TMS, SAINT, MeRT, MRI-guided/navigated TMS, ketamine adjunct, maintenance), and cranial electrical stimulation for any indication are considered experimental/investigational and not covered. Coverage criteria include: TMS for major depressive disorder is medically necessary only when ALL of the following criteria are met (criteria 1-9 below).; Administered using an FDA-cleared TMS device (includes intermittent theta-burst stimulation/iTBS) used per its FDA-labeled indications.; Member is age 15 years or older.; Confirmed diagnosis by a psychiatrist of severe major depressive disorder (single or recurrent episode) without psychosis, documented by standardized rating scales (e.g., BDI, HDRS, MADRS).; Member has no contraindications to TMS.; Inadequate response to prior pharmacotherapy demonstrated by BOTH of the following: (a) trial of two antidepressants from at least 2 different agent classes, each at a maximally tolerated labeled dose for at least 8 weeks; AND (b) augmentation therapy added to the primary antidepressant for at least 8 weeks.; Treatment limited to a maximum of 30 sessions (5 days a week for 6 weeks) plus up to 6 tapering sessions.; Device used is FDA-approved/cleared for the treatment of major depressive disorder.; Treatment is ordered by a psychiatrist (MD/DO) or a psychiatric-mental health nurse practitioner (PMHNP) with direct supervision.; TMS is administered by a clinical professional/trained TMS operator working under the supervision of a physician, NP, or PA who is present in the treatment room.; TMS RETREATMENT is medically necessary only when ALL of the following are met: member previously met the initiation criteria; member relapsed following prior TMS despite other treatments; the prior TMS course produced a response of at least a 50% reduction in depressive symptoms that was maintained for at least 2 months. (Repeat TMS within 60 days following termination of a prior course is considered NOT medically necessary.); RE-MAPPING: one re-mapping session is medically necessary; additional re-mapping sessions are medically necessary only if there is no response or there are motor threshold concerns.. Applies to 3 codes: 90867, 90868, 90869.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Confirmed diagnosis of severe major depressive disorder by a psychiatrist, documented with standardized rating scales (e.g., BDI, HDRS, MADRS).; Documentation of inadequate response to two antidepressants from at least 2 different classes (each at maximally tolerated labeled dose for at least 8 weeks) plus augmentation therapy for at least 8 weeks.; Documentation of psychiatrist/PMHNP examination, record review, patient-selection determination, motor threshold assessment, mapping, and treatment parameter oversight.; For retreatment: documentation that the prior TMS course produced at least a 50% reduction in depressive symptoms maintained for at least 2 months.
Trap
Policy exclusions and limitations: CONTRAINDICATION (TMS not medically necessary): history of substance abuse within the last 90 days.; CONTRAINDICATION (TMS not medically necessary): active suicidality.; CONTRAINDICATION (TMS not medically necessary): metal implants in or around the head (e.g., aneurysm coil, clip, plate, ocular implant, stent).; CONTRAINDICATION (TMS not medically necessary): metal or fragments within 30 cm of the treatment coil.; CONTRAINDICATION (TMS not medically necessary): neurological conditions (e.g., CVA/stroke, dementia, severe head trauma, increased intracranial pressure, CNS tumors).; CONTRAINDICATION (TMS not medically necessary): implanted devices (e.g., pacemaker, defibrillator, cochlear implant, deep brain stimulator, infusion pump, spinal cord stimulator, vagus nerve stimulator).; CONTRAINDICATION (TMS not medically necessary): severe cardiovascular disease, unless cleared by a cardiologist.; CONTRAINDICATION (TMS not medically necessary): ferromagnetic-containing tattoos of the head/neck.; CONTRAINDICATION (TMS not medically necessary): unstable medical disorders.; Repeat TMS within 60 days following termination of a prior TMS course is considered not medically necessary.; Accelerated TMS (experimental/investigational/unproven, not medically necessary).; MRI-guided TMS, including repetitive and theta-burst stimulation (experimental/investigational).; Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) (experimental/investigational).; Adjunctive use of ketamine with TMS (experimental/investigational).; Combined TMS and electroencephalography (EEG) for evaluation of unconscious state (experimental/investigational).; Delivery of TMS using a non-standard protocol with increased hertz under sedation (experimental/investigational).; Navigated TMS for motor function mapping and/or treatment planning of neurological diseases (experimental/investigational).; Magnetic e-Resonance Therapy (MeRT) for all indications (experimental/investigational).; TMS maintenance therapy (treatment outside the established 30 sessions plus 6 tapering sessions) (experimental/investigational).; TMS for Alzheimer's disease (experimental/investigational/not medically necessary).; TMS for amyotrophic lateral sclerosis (ALS).; TMS for anxiety disorders.; TMS for auditory verbal hallucinations.; TMS for bipolar disorder.; TMS for blepharospasm.; TMS for bulimia nervosa.; TMS for cerebellar ataxia (including spinocerebellar ataxia type 3).; TMS for cerebral palsy.; TMS for chronic pain, including neuropathic pain.; TMS for orofacial pain.; TMS for central post-stroke pain.; TMS for communication and swallowing disorders.; TMS for aphasia (including post-stroke aphasia).; TMS for dysarthria.; TMS for dysphagia (including post-stroke dysphagia).; TMS for linguistic deficits.; TMS for complex regional pain syndrome (CRPS).; TMS for concussion.; TMS for differential diagnosis of Alzheimer disease from frontotemporal dementia.; TMS for executive function deficits.; TMS for epilepsy (including status epilepticus).; TMS for congenital hemiparesis.; TMS for dyslexia.; TMS for dystonia.; TMS for fibromyalgia.; TMS for functional neurological disorder.; TMS for gambling disorder.; TMS for insomnia.; TMS for levodopa-induced dyskinesia.; TMS for major depressive disorder with psychosis.; TMS for migraine.; TMS for mood disorders.; TMS for multiple sclerosis.; TMS for musical obsession (stuck song syndrome).; TMS for neurodevelopmental disorders.; TMS for attention deficit/hyperactivity disorder (ADHD).; TMS for autism spectrum disorder.; TMS for tic disorders.; TMS for neuropathic pain associated with spinal cord injury.; TMS for obsessive-compulsive disorder (OCD).; TMS for panic disorder.; TMS for Parkinson disease.; TMS for peri-partum depression.; TMS for phantom limb pain.; TMS for phantom pain associated with spinal cord injury.; TMS for post-stroke fatigue.; TMS for post-traumatic stress disorder (PTSD).; TMS for psychosis.; TMS for restless legs syndrome.; TMS for schizo-affective disorder.; TMS for schizophrenia.; TMS for smell and taste dysfunction.; TMS for phantosmia.; TMS for phantageusia.; TMS for smoking cessation.; TMS for somatic symptom disorder.; TMS for somatization disorder.; TMS for spasticity.; TMS for stroke treatment.; TMS for motor impairment (stroke-related).; TMS for post-stroke hemiplegia.; TMS for post-stroke spasticity.; TMS for substance addiction.; TMS for substance use disorders.; TMS for Tourette syndrome.; TMS for tinnitus.; TMS for traumatic brain injury (TBI).; TMS for visual hallucinations after stroke.; Cranial electrical stimulation (CES) is considered experimental/investigational/unproven for all indications, including the following.; CES for alcoholism.; CES for Alzheimer's disease.; CES for anxiety.; CES for autism.; CES for chemical dependency.; CES for chronic pain.; CES for dementia.; CES for depression.; CES for disorders of consciousness.; CES for dyslexia.; CES for headaches.; CES for fibromyalgia.; CES for insomnia.; CES for mood and sleep disturbances.; CES for neuropathic pain.; CES for Parkinson disease.; CES for phantom pain associated with spinal cord injury.; CES for progressive supranuclear palsy.; CES for restless legs syndrome.; CES for stroke treatment.; CES for motor impairment.; CES for post-stroke aphasia.; CES for post-stroke hemiplegia.; CES for traumatic brain injury (TBI).; CES for visual rehabilitation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source: Aetna CPB 0469 — Transcranial Magnetic Stimulation (TMS)

Coverage criteria

  • TMS for major depressive disorder is medically necessary only when ALL of the following criteria are met (criteria 1-9 below).
  • Administered using an FDA-cleared TMS device (includes intermittent theta-burst stimulation/iTBS) used per its FDA-labeled indications.
  • Member is age 15 years or older.
  • Confirmed diagnosis by a psychiatrist of severe major depressive disorder (single or recurrent episode) without psychosis, documented by standardized rating scales (e.g., BDI, HDRS, MADRS).
  • Member has no contraindications to TMS.
  • Inadequate response to prior pharmacotherapy demonstrated by BOTH of the following: (a) trial of two antidepressants from at least 2 different agent classes, each at a maximally tolerated labeled dose for at least 8 weeks; AND (b) augmentation therapy added to the primary antidepressant for at least 8 weeks.
  • Treatment limited to a maximum of 30 sessions (5 days a week for 6 weeks) plus up to 6 tapering sessions.
  • Device used is FDA-approved/cleared for the treatment of major depressive disorder.
  • Treatment is ordered by a psychiatrist (MD/DO) or a psychiatric-mental health nurse practitioner (PMHNP) with direct supervision.
  • TMS is administered by a clinical professional/trained TMS operator working under the supervision of a physician, NP, or PA who is present in the treatment room.
  • TMS RETREATMENT is medically necessary only when ALL of the following are met: member previously met the initiation criteria; member relapsed following prior TMS despite other treatments; the prior TMS course produced a response of at least a 50% reduction in depressive symptoms that was maintained for at least 2 months. (Repeat TMS within 60 days following termination of a prior course is considered NOT medically necessary.)
  • RE-MAPPING: one re-mapping session is medically necessary; additional re-mapping sessions are medically necessary only if there is no response or there are motor threshold concerns.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Documentation required

  • Confirmed diagnosis of severe major depressive disorder by a psychiatrist, documented with standardized rating scales (e.g., BDI, HDRS, MADRS).
  • Documentation of inadequate response to two antidepressants from at least 2 different classes (each at maximally tolerated labeled dose for at least 8 weeks) plus augmentation therapy for at least 8 weeks.
  • Documentation of psychiatrist/PMHNP examination, record review, patient-selection determination, motor threshold assessment, mapping, and treatment parameter oversight.
  • For retreatment: documentation that the prior TMS course produced at least a 50% reduction in depressive symptoms maintained for at least 2 months.

Frequently asked questions

When does Aetna cover Transcranial Magnetic Stimulation (TMS) (CPT 90867), and what gets it denied?
Aetna covers transcranial magnetic stimulation (TMS) only for severe major depressive disorder (without psychosis) in members age 15 or older, using an FDA-cleared device, after the member has failed adequate trials of two antidepressants from different classes plus augmentation therapy and has no contraindications; treatment is capped at 30 sessions plus up to 6 tapering sessions, with retreatment allowed only after a documented 50% response sustained 2+ months. TMS for essentially all other neurologic/psychiatric conditions, newer protocols (accelerated TMS, SAINT, MeRT, MRI-guided/navigated TMS, ketamine adjunct, maintenance), and cranial electrical stimulation for any indication are considered experimental/investigational and not covered. Coverage criteria include: TMS for major depressive disorder is medically necessary only when ALL of the following criteria are met (criteria 1-9 below).; Administered using an FDA-cleared TMS device (includes intermittent theta-burst stimulation/iTBS) used per its FDA-labeled indications.; Member is age 15 years or older.; Confirmed diagnosis by a psychiatrist of severe major depressive disorder (single or recurrent episode) without psychosis, documented by standardized rating scales (e.g., BDI, HDRS, MADRS).; Member has no contraindications to TMS.; Inadequate response to prior pharmacotherapy demonstrated by BOTH of the following: (a) trial of two antidepressants from at least 2 different agent classes, each at a maximally tolerated labeled dose for at least 8 weeks; AND (b) augmentation therapy added to the primary antidepressant for at least 8 weeks.; Treatment limited to a maximum of 30 sessions (5 days a week for 6 weeks) plus up to 6 tapering sessions.; Device used is FDA-approved/cleared for the treatment of major depressive disorder.; Treatment is ordered by a psychiatrist (MD/DO) or a psychiatric-mental health nurse practitioner (PMHNP) with direct supervision.; TMS is administered by a clinical professional/trained TMS operator working under the supervision of a physician, NP, or PA who is present in the treatment room.; TMS RETREATMENT is medically necessary only when ALL of the following are met: member previously met the initiation criteria; member relapsed following prior TMS despite other treatments; the prior TMS course produced a response of at least a 50% reduction in depressive symptoms that was maintained for at least 2 months. (Repeat TMS within 60 days following termination of a prior course is considered NOT medically necessary.); RE-MAPPING: one re-mapping session is medically necessary; additional re-mapping sessions are medically necessary only if there is no response or there are motor threshold concerns.. Applies to 3 codes: 90867, 90868, 90869. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Confirmed diagnosis of severe major depressive disorder by a psychiatrist, documented with standardized rating scales (e.g., BDI, HDRS, MADRS).; Documentation of inadequate response to two antidepressants from at least 2 different classes (each at maximally tolerated labeled dose for at least 8 weeks) plus augmentation therapy for at least 8 weeks.; Documentation of psychiatrist/PMHNP examination, record review, patient-selection determination, motor threshold assessment, mapping, and treatment parameter oversight.; For retreatment: documentation that the prior TMS course produced at least a 50% reduction in depressive symptoms maintained for at least 2 months. Policy exclusions and limitations: CONTRAINDICATION (TMS not medically necessary): history of substance abuse within the last 90 days.; CONTRAINDICATION (TMS not medically necessary): active suicidality.; CONTRAINDICATION (TMS not medically necessary): metal implants in or around the head (e.g., aneurysm coil, clip, plate, ocular implant, stent).; CONTRAINDICATION (TMS not medically necessary): metal or fragments within 30 cm of the treatment coil.; CONTRAINDICATION (TMS not medically necessary): neurological conditions (e.g., CVA/stroke, dementia, severe head trauma, increased intracranial pressure, CNS tumors).; CONTRAINDICATION (TMS not medically necessary): implanted devices (e.g., pacemaker, defibrillator, cochlear implant, deep brain stimulator, infusion pump, spinal cord stimulator, vagus nerve stimulator).; CONTRAINDICATION (TMS not medically necessary): severe cardiovascular disease, unless cleared by a cardiologist.; CONTRAINDICATION (TMS not medically necessary): ferromagnetic-containing tattoos of the head/neck.; CONTRAINDICATION (TMS not medically necessary): unstable medical disorders.; Repeat TMS within 60 days following termination of a prior TMS course is considered not medically necessary.; Accelerated TMS (experimental/investigational/unproven, not medically necessary).; MRI-guided TMS, including repetitive and theta-burst stimulation (experimental/investigational).; Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) (experimental/investigational).; Adjunctive use of ketamine with TMS (experimental/investigational).; Combined TMS and electroencephalography (EEG) for evaluation of unconscious state (experimental/investigational).; Delivery of TMS using a non-standard protocol with increased hertz under sedation (experimental/investigational).; Navigated TMS for motor function mapping and/or treatment planning of neurological diseases (experimental/investigational).; Magnetic e-Resonance Therapy (MeRT) for all indications (experimental/investigational).; TMS maintenance therapy (treatment outside the established 30 sessions plus 6 tapering sessions) (experimental/investigational).; TMS for Alzheimer's disease (experimental/investigational/not medically necessary).; TMS for amyotrophic lateral sclerosis (ALS).; TMS for anxiety disorders.; TMS for auditory verbal hallucinations.; TMS for bipolar disorder.; TMS for blepharospasm.; TMS for bulimia nervosa.; TMS for cerebellar ataxia (including spinocerebellar ataxia type 3).; TMS for cerebral palsy.; TMS for chronic pain, including neuropathic pain.; TMS for orofacial pain.; TMS for central post-stroke pain.; TMS for communication and swallowing disorders.; TMS for aphasia (including post-stroke aphasia).; TMS for dysarthria.; TMS for dysphagia (including post-stroke dysphagia).; TMS for linguistic deficits.; TMS for complex regional pain syndrome (CRPS).; TMS for concussion.; TMS for differential diagnosis of Alzheimer disease from frontotemporal dementia.; TMS for executive function deficits.; TMS for epilepsy (including status epilepticus).; TMS for congenital hemiparesis.; TMS for dyslexia.; TMS for dystonia.; TMS for fibromyalgia.; TMS for functional neurological disorder.; TMS for gambling disorder.; TMS for insomnia.; TMS for levodopa-induced dyskinesia.; TMS for major depressive disorder with psychosis.; TMS for migraine.; TMS for mood disorders.; TMS for multiple sclerosis.; TMS for musical obsession (stuck song syndrome).; TMS for neurodevelopmental disorders.; TMS for attention deficit/hyperactivity disorder (ADHD).; TMS for autism spectrum disorder.; TMS for tic disorders.; TMS for neuropathic pain associated with spinal cord injury.; TMS for obsessive-compulsive disorder (OCD).; TMS for panic disorder.; TMS for Parkinson disease.; TMS for peri-partum depression.; TMS for phantom limb pain.; TMS for phantom pain associated with spinal cord injury.; TMS for post-stroke fatigue.; TMS for post-traumatic stress disorder (PTSD).; TMS for psychosis.; TMS for restless legs syndrome.; TMS for schizo-affective disorder.; TMS for schizophrenia.; TMS for smell and taste dysfunction.; TMS for phantosmia.; TMS for phantageusia.; TMS for smoking cessation.; TMS for somatic symptom disorder.; TMS for somatization disorder.; TMS for spasticity.; TMS for stroke treatment.; TMS for motor impairment (stroke-related).; TMS for post-stroke hemiplegia.; TMS for post-stroke spasticity.; TMS for substance addiction.; TMS for substance use disorders.; TMS for Tourette syndrome.; TMS for tinnitus.; TMS for traumatic brain injury (TBI).; TMS for visual hallucinations after stroke.; Cranial electrical stimulation (CES) is considered experimental/investigational/unproven for all indications, including the following.; CES for alcoholism.; CES for Alzheimer's disease.; CES for anxiety.; CES for autism.; CES for chemical dependency.; CES for chronic pain.; CES for dementia.; CES for depression.; CES for disorders of consciousness.; CES for dyslexia.; CES for headaches.; CES for fibromyalgia.; CES for insomnia.; CES for mood and sleep disturbances.; CES for neuropathic pain.; CES for Parkinson disease.; CES for phantom pain associated with spinal cord injury.; CES for progressive supranuclear palsy.; CES for restless legs syndrome.; CES for stroke treatment.; CES for motor impairment.; CES for post-stroke aphasia.; CES for post-stroke hemiplegia.; CES for traumatic brain injury (TBI).; CES for visual rehabilitation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.
Does Aetna require prior authorization for Transcranial Magnetic Stimulation (TMS)?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Confirmed diagnosis of severe major depressive disorder by a psychiatrist, documented with standardized rating scales (e.g., BDI, HDRS, MADRS).; Documentation of inadequate response to two antidepressants from at least 2 different classes (each at maximally tolerated labeled dose for at least 8 weeks) plus augmentation therapy for at least 8 weeks.; Documentation of psychiatrist/PMHNP examination, record review, patient-selection determination, motor threshold assessment, mapping, and treatment parameter oversight.; For retreatment: documentation that the prior TMS course produced at least a 50% reduction in depressive symptoms maintained for at least 2 months.
What does Aetna exclude for Transcranial Magnetic Stimulation (TMS)?
Policy exclusions and limitations: CONTRAINDICATION (TMS not medically necessary): history of substance abuse within the last 90 days.; CONTRAINDICATION (TMS not medically necessary): active suicidality.; CONTRAINDICATION (TMS not medically necessary): metal implants in or around the head (e.g., aneurysm coil, clip, plate, ocular implant, stent).; CONTRAINDICATION (TMS not medically necessary): metal or fragments within 30 cm of the treatment coil.; CONTRAINDICATION (TMS not medically necessary): neurological conditions (e.g., CVA/stroke, dementia, severe head trauma, increased intracranial pressure, CNS tumors).; CONTRAINDICATION (TMS not medically necessary): implanted devices (e.g., pacemaker, defibrillator, cochlear implant, deep brain stimulator, infusion pump, spinal cord stimulator, vagus nerve stimulator).; CONTRAINDICATION (TMS not medically necessary): severe cardiovascular disease, unless cleared by a cardiologist.; CONTRAINDICATION (TMS not medically necessary): ferromagnetic-containing tattoos of the head/neck.; CONTRAINDICATION (TMS not medically necessary): unstable medical disorders.; Repeat TMS within 60 days following termination of a prior TMS course is considered not medically necessary.; Accelerated TMS (experimental/investigational/unproven, not medically necessary).; MRI-guided TMS, including repetitive and theta-burst stimulation (experimental/investigational).; Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) (experimental/investigational).; Adjunctive use of ketamine with TMS (experimental/investigational).; Combined TMS and electroencephalography (EEG) for evaluation of unconscious state (experimental/investigational).; Delivery of TMS using a non-standard protocol with increased hertz under sedation (experimental/investigational).; Navigated TMS for motor function mapping and/or treatment planning of neurological diseases (experimental/investigational).; Magnetic e-Resonance Therapy (MeRT) for all indications (experimental/investigational).; TMS maintenance therapy (treatment outside the established 30 sessions plus 6 tapering sessions) (experimental/investigational).; TMS for Alzheimer's disease (experimental/investigational/not medically necessary).; TMS for amyotrophic lateral sclerosis (ALS).; TMS for anxiety disorders.; TMS for auditory verbal hallucinations.; TMS for bipolar disorder.; TMS for blepharospasm.; TMS for bulimia nervosa.; TMS for cerebellar ataxia (including spinocerebellar ataxia type 3).; TMS for cerebral palsy.; TMS for chronic pain, including neuropathic pain.; TMS for orofacial pain.; TMS for central post-stroke pain.; TMS for communication and swallowing disorders.; TMS for aphasia (including post-stroke aphasia).; TMS for dysarthria.; TMS for dysphagia (including post-stroke dysphagia).; TMS for linguistic deficits.; TMS for complex regional pain syndrome (CRPS).; TMS for concussion.; TMS for differential diagnosis of Alzheimer disease from frontotemporal dementia.; TMS for executive function deficits.; TMS for epilepsy (including status epilepticus).; TMS for congenital hemiparesis.; TMS for dyslexia.; TMS for dystonia.; TMS for fibromyalgia.; TMS for functional neurological disorder.; TMS for gambling disorder.; TMS for insomnia.; TMS for levodopa-induced dyskinesia.; TMS for major depressive disorder with psychosis.; TMS for migraine.; TMS for mood disorders.; TMS for multiple sclerosis.; TMS for musical obsession (stuck song syndrome).; TMS for neurodevelopmental disorders.; TMS for attention deficit/hyperactivity disorder (ADHD).; TMS for autism spectrum disorder.; TMS for tic disorders.; TMS for neuropathic pain associated with spinal cord injury.; TMS for obsessive-compulsive disorder (OCD).; TMS for panic disorder.; TMS for Parkinson disease.; TMS for peri-partum depression.; TMS for phantom limb pain.; TMS for phantom pain associated with spinal cord injury.; TMS for post-stroke fatigue.; TMS for post-traumatic stress disorder (PTSD).; TMS for psychosis.; TMS for restless legs syndrome.; TMS for schizo-affective disorder.; TMS for schizophrenia.; TMS for smell and taste dysfunction.; TMS for phantosmia.; TMS for phantageusia.; TMS for smoking cessation.; TMS for somatic symptom disorder.; TMS for somatization disorder.; TMS for spasticity.; TMS for stroke treatment.; TMS for motor impairment (stroke-related).; TMS for post-stroke hemiplegia.; TMS for post-stroke spasticity.; TMS for substance addiction.; TMS for substance use disorders.; TMS for Tourette syndrome.; TMS for tinnitus.; TMS for traumatic brain injury (TBI).; TMS for visual hallucinations after stroke.; Cranial electrical stimulation (CES) is considered experimental/investigational/unproven for all indications, including the following.; CES for alcoholism.; CES for Alzheimer's disease.; CES for anxiety.; CES for autism.; CES for chemical dependency.; CES for chronic pain.; CES for dementia.; CES for depression.; CES for disorders of consciousness.; CES for dyslexia.; CES for headaches.; CES for fibromyalgia.; CES for insomnia.; CES for mood and sleep disturbances.; CES for neuropathic pain.; CES for Parkinson disease.; CES for phantom pain associated with spinal cord injury.; CES for progressive supranuclear palsy.; CES for restless legs syndrome.; CES for stroke treatment.; CES for motor impairment.; CES for post-stroke aphasia.; CES for post-stroke hemiplegia.; CES for traumatic brain injury (TBI).; CES for visual rehabilitation. Claims may be denied when the requested service falls under these. Some of these are conditional (note the stated exceptions) — confirm specifics against the bulletin.

Source

Aetna CPB 0469 — Transcranial Magnetic Stimulation (TMS)

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This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0469 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.