We are pleased to announce the adoption and implementation of a new Transcranial Magnetic Stimulation coverage policy with Cigna, effective 3/28/16. This coverage decision will now provide access to TMS for approximately 14.7 Million members nationwide.  Please conduct a benefit investigation to learn more about benefits for your patients. 

Plan Description:

Cigna is a member health plan serving HMO, PPO, Medicare Advantage, and Managed Cigna-insurance-logoMedicaid members.

 

Policy Information:

Transcranial Magnetic Stimulation Medical Policy 0383...

Coverage Policy Cigna covers an initial regimen of transcranial magnetic stimulation (TMS) using an FDA approved device as 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, without psychosis, as defined by the most recent edition of Diagnostic and Statistical Manual of Mental Disorders • one of the following criteria: during the current episode of depression ALL of the following criteria are met: for at least three trials of antidepressant medications, at adequate therapeutic doses, from at least two different antidepressant agent classes, for at least four weeks o no significant reduction in depressive symptoms following pharmacotherapy as documented by validated depression monitoring scales o 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, as documented by validated depression monitoring scales during the current episode of depression BOTH of the following criteria are met: intolerance or has a medical contraindication to at least three antidepressant medications, at adequate therapeutic doses, from at least two different antidepressant agent classes, for at least four weeks 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, as documented by validated depression monitoring scales Page 2 of 34 Coverage Policy Number: 0383 has a history of a favorable response to transcranial magnetic stimulation in a previous episode, as evidenced by a greater than 50% improvement in a standard rating scale for depressive Cigna covers repeat transcranial magnetic stimulation (TMS) for an acute relapse of major depressive disorder as medically necessary when BOTH of the following criteria are met: • all of the above criteria for initial therapy are met • had more than a 50% improvement in prior TMS treatments as evidenced by standard rating scale for depressive symptoms Cigna does not cover transcranial magnetic stimulation (TMS) for any other indication or as a maintenance therapy because it is considered experimental, investigational or unproven.

 

Policy Link:
The coverage medical policy is publicly available via the website: Click here to view the Cigna Medical Coverage Policy 

 

Applicable CPT and Diagnosis Codes:

CPT Codes:                  

  • 90867: Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management
  • 90868: Therapeutic repetitive Transcranial Magnetic Stimulation (TMS) treatment; subsequent delivery and management, per session
  • 90869: Therapeutic repetitive Transcranial Magnetic Stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management

 

Experimental/Investigational/Unproven/Not Covered for any indication:

0310T - Motor function mapping using non-invasive navigated transcranial magnetic stimulation (nTMS) for therapeutic treatment planning, upper and lower extremity

 

Diagnosis Codes*:  NOT DOCUMENTED IN MEDICAL POLICY

Policy does reference the below language:

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

 

Disclaimer and Indication:

All reimbursement information provided by Neuronetics is for general guidance only. It does not represent a statement, promise, or guarantee by Neuronetics concerning levels of reimbursement, payment, or charge, if any. Coverage and payment for NeuroStar TMS Therapy is based on various factors, including but not limited to; medical necessity, the patient's specific benefits plan, and individual insurance company's policies and guidelines. It is the responsibility of the physician and patient to be knowledgeable of the applicable guidelines.

 *Please note: When selecting a diagnosis, it is the obligation of the provider to code to the highest level of specificity.

 


 

If you'd like to talk to a TMS Solutions specialist about TMS Therapy and if your insurance covers treatment, click on the button below. We'd be happy to talk with you.

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NeuroStar TMS Therapy® is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.

Topics: Press Release, Insurance Coverage