Key takeaways
- Your exact Florida Blue product determines which benefits and authorization rules apply.
- The Florida Blue-specific Lucet policy has its own age, medication, symptom-rating, and protocol criteria.
- Approval for another course depends on previous benefit, relapse, and current eligibility.
- We review your benefits and explain expected out-of-pocket costs before treatment.
Florida Blue TMS coverage at a glance
The following summarizes Lucet’s 2026 Florida Blue policy. Medicare Advantage, Federal Employee Program, and other Blue plans need separate verification.
| Coverage question | Published policy summary |
|---|---|
| Diagnosis | Severe major depressive disorder without psychosis |
| Age | 15–70 |
| Medication nonresponse | Two unsuccessful antidepressant trials from two classes |
| Medication intolerance | Two trials from two classes with documented distinct intolerable side effects |
| Fixed trial duration | No universal week minimum stated in the eligibility section |
| Symptom monitoring | Same scale before treatment, every two weeks, and at the final visit |
| Treatment schedule | One session per weekday for six weeks |
| Taper | Three, then two, then one session over the following three weeks |
| Repeat course | Initial criteria met again, previous improvement ≥50%, and ≥90 days since the last course ended |
| Excluded approaches | iTBS, maintenance TMS, OCD treatment, and navigated TMS |
| Authorization | Verify benefits and submit the applicable Lucet/plan request |
Coverage question
Diagnosis
Severe major depressive disorder without psychosis
Age
15–70
Medication nonresponse
Two unsuccessful antidepressant trials from two classes
Medication intolerance
Two trials from two classes with documented distinct intolerable side effects
Fixed trial duration
No universal week minimum stated in the eligibility section
Symptom monitoring
Same scale before treatment, every two weeks, and at the final visit
Treatment schedule
One session per weekday for six weeks
Taper
Three, then two, then one session over the following three weeks
Repeat course
Initial criteria met again, previous improvement ≥50%, and ≥90 days since the last course ended
Excluded approaches
iTBS, maintenance TMS, OCD treatment, and navigated TMS
Authorization
Verify benefits and submit the applicable Lucet/plan request
Depression rating-scale thresholds
| Assessment | Initial threshold listed |
|---|---|
| BDI | Greater than 29 |
| IDS-C | Greater than 36 |
| QIDS-SR | Greater than 15 |
| MADRS | Greater than 34 |
| PHQ-9 | Greater than 19 |
Assessment
BDI
Greater than 29
IDS-C
Greater than 36
QIDS-SR
Greater than 15
MADRS
Greater than 34
PHQ-9
Greater than 19
These assessments support a clinical evaluation. You do not need to choose a scale or interpret your score yourself.
The policy also has a separate ECT-based pathway: ECT eligibility and evaluation must be documented, clinical circumstances must prevent ECT, and ECT must not be the superior option. Simply declining ECT does not establish this pathway.
Which Florida Blue policy applies to you?
The name on your card is the starting point. We also need to identify your specific product, behavioral health administrator, network, and benefits.
If you have a Medicare Advantage plan, applicable Medicare coverage criteria must be considered. The commercial age limits and medication rules above should not automatically be carried over to Medicare Advantage.
Bring your complete insurance information so we can confirm the right review process.
What information helps with authorization?
Useful records include:
- Medication names, doses, start and stop dates, and results.
- Specific side effects and why a medication could not be continued.
- Current psychiatric notes and previous treatment records.
- Previous TMS dates and outcomes, if applicable.
- Relevant medical history and current medications.
Our team helps organize the records needed for your request. A consultation also establishes whether the proposed treatment is appropriate for you.
What will TMS cost with Florida Blue?
Your responsibility depends on your remaining deductible, copayments or coinsurance, network status, and approved services. Two Florida Blue members can have different costs.
We provide a personalized benefits estimate before you begin and explain how the proposed schedule fits your coverage.
Frequently asked questions
Yes. Send us your plan information. We identify the home plan and applicable behavioral health rules before applying a coverage checklist.
Records explaining the medication, dose, dates, side effects, and reason for stopping are helpful. A medication list alone may not give the reviewer enough information.
Our team can explain which records are useful and help coordinate requests with your other clinicians. Having dates and prescriber names available can make that process easier.
Contact us for a new clinical assessment. We review your previous course, documented response, current symptoms, and the applicable repeat-treatment requirements.
No. An authorization and your financial benefits answer different questions. We explain the estimated patient share as part of the coverage review.
Request your Florida Blue TMS coverage check
If depression has not improved enough with medication, our team can help you understand the next step.
Florida TMS Clinic provides TMS care in Wesley Chapel and Tampa.
Call (813) 867-2378 or request a coverage check.
Compare TMS coverage across insurance plans.
Policy information checked November 1, 2026. Coverage depends on your specific benefits, medical necessity, network participation, and required authorization. Verification and authorization do not guarantee payment.
Official policy references
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.