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Aetna Transcranial Magnetic Stimulation Therapy Coverage Policy
Aetna Transcranial Magnetic Stimulation Therapy Coverage Policy
Does Aetna cover TMS therapy? Aetna covers TMS therapy when the following criteria are met:
Does Aetna cover TMS therapy? Aetna covers TMS therapy when the following criteria are met:
Age 18 years or older
The member has severe major depressive disorder (single or recurrent episode)
Failure of a trial of psychotherapy
Inadequate response to 4 antidepressants and augmentation therapy
Below are the details of Aetna’s TMS therapy coverage policy in 2020.
Below are the details of Aetna’s TMS therapy coverage policy in 2020.
Aetna considers transcranial magnetic stimulation (TMS) in a healthcare provider’s office medically necessary when the following criteria are met:
Administered by an FDA cleared device and utilized in accordance with the Food and Drug Administration (FDA) labeled indications; and
The member is age 18 years or older; and
The member has a confirmed diagnosis by a psychiatrist of severe major depressive disorder (single or recurrent episode), documented by standardized rating scales that reliably measure depressive symptoms (eg, Beck Depression Scale [BDI], Hamilton Depression Rating Scale [HDRS], Montgomery-Asberg Depression Rating Scale [MADRS], etc.); and
There is documentation via legible medical records of failure of a trial of a psychotherapy known to be effective in the treatment of major depressive disorder of an adequate frequency and duration, without significant improvement in depressive symptoms, as documented by standardized rating scales that reliably measure depressive symptoms (e.g., Beck Depression Scale [BDI], Hamilton Depression Rating Scale [HDRS], Montgomery-Asberg Depression Rating Scale [MADRS], etc.); and
The member is currently receiving or is a candidate for electroconvulsive therapy (ECT) and TMS is considered a less invasive equally effective treatment option (e.g., in cases with psychosis, acute suicidal risk, catatonia or life-threatening inanition TMS should not be utilized); and
The member has no contraindications to TMS (refer to contraindications below); and
The member has experienced inadequate response during the current depressive episode with:
Two antidepressants from at least 2 different classes having different mechanisms of action (see Appendix) at the maximally tolerated labeled dose, each used for at least 8 weeks; and
Augmentation therapy
TMS For Depression Tampa.pdfTMS Clinic Tampa.pdfAccelerated TMS Tampa.pdfTranscranial Magnetic Stimulation Therapy Tampa.pdfTMS Tampa.pdfTMS Therapy Tampa.pdfTranscranial Magnetic Stimulation Tampa.pdfTMS Therapy For Depression Tampa.pdf
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