Does Florida Blue cover TMS therapy?

Yes. Florida Blue considers TMS medically necessary for severe major depressive disorder without psychosis when policy criteria are met, including rating-scale documentation, age 15–70, and inadequate response or intolerance to antidepressants.

How many TMS sessions does Florida Blue cover?

A standard course covers 30 treatment sessions (5/day per week for 6 weeks) followed by a 3-week taper (3, then 2, then 1 session).

What is Florida Blue’s retreatment policy?

Retreatment may be covered after relapse if you meet initiation criteria again, previously improved ≥50% on a standardized depression scale, and at least 90 days have elapsed since the prior course.

Are theta-burst or maintenance TMS covered?

Intermittent theta burst stimulation (iTBS) and maintenance TMS are listed as non-covered in this guideline.

TMS Therapy Coverage Florida Blue | FLORIDA TMS CLINIC

In-network, outcomes-focused

TMS that fits your Florida Blue plan — and your life

We serve Tampa and Wesley Chapel with a comprehensive program: psychiatric evaluation, measurement-based care (PHQ-9, BDI, MADRS, QIDS-SR, IDS-C), FDA-cleared protocols, and collaborative follow-up with your therapist or PCP. We submit the full authorization packet, monitor symptom scores every two weeks during treatment, and keep you informed at each step.

In-network for Florida Blue
Measurement-based care with validated rating scales
Clear expectations on session count, retreatment, and documentation
Flexible scheduling and quick turnarounds on pre-auth

Florida Blue TMS Coverage: Eligibility & What’s Included

Florida Blue deems TMS medically necessary for major depressive disorder when all of the following are met.

Eligibility checklist (MDD)

Diagnosis: Severe MDD without psychosis confirmed by a clinician

Validated scales: Use one rating scale consistently (BDI, IDS-C, QIDS-SR, MADRS, PHQ-9) with baseline and bi-weekly tracking; Florida Blue specifies minimum baseline thresholds to qualify:

Scale	Items	Minimum Score
Beck Depression Inventory (BDI)	21	> 29
Inventory of Depressive Symptomatology — Clinician (IDS-C)	30	> 36
Quick Inventory of Depressive Symptomatology — Self Report (QIDS-SR)	16	> 15
Montgomery-Åsberg Depression Rating Scale (MADRS)	10	> 34
Patient Health Questionnaire (PHQ-9)	9	> 19

Age: 15–70
Treatment history: Either:
- Failure of 2 antidepressant trials from two different classes, or
- Intolerance to two adequate trials, or
- TMS judged less invasive than ECT or patient unwilling to consent to ECT
Monitoring: Bi-weekly rating-scale testing during the 6-week course and a final test at the last visit

Session limits & retreatment

Initial course: 1 session/day, 5 days/week, for 6 weeks(30 sessions) followed by a 3-week taper(week 1: 3 sessions; week 2: 2; week 3: 1)
Retreatment (after relapse): Covered when:
- All initial criteria are met again, and
- Prior course achieved ≥50% improvement on a standardized scale, and
- At least 90 days have elapsed since the last course

Requests not meeting these thresholds are not considered medically necessary.

Exclusions & non-covered items

Maintenance/booster TMS outside the above course
Intermittent Theta Burst Stimulation (iTBS) and Magnetic Seizure Therapy (MST)
OCD treatment with dTMS (BrainsWay H-coil) and other non-MDD indications
Navigated TMS (nTMS) for any indication
Active psychosis, acute suicidality, catatonia, life-threatening functional compromise
Active substance abuse (UDS may be required)
Non-removable metallic implants/objects in head/neck; certain neurologic conditions

Your specific benefits and any mandates still control coverage and cost-share.

Program exceptions, supervision & coding

Lucet: For select Florida Blue products, outpatient/office TMS coverage decisions are handled by Lucet. We coordinate directly with Lucet during pre-auth.
Supervision: Attending physician is a board-certified psychiatrist with TMS training; first session and motor-threshold re-determination performed by the attending; technicians administering 90868 require certification under direct supervision.
Common CPT codes: 90867 (initial), 90868 (per session), 90869 (re-det MT). Authorizations often approve 1 × 90867, 36 × 90868, and 1 × 90869, with additional 90869 as clinically justified.

We’ll verify your member-specific benefits, confirm eligibility with Florida Blue/Lucet when applicable, and give you a clear out-of-pocket estimate before your first session.

What TMS Is — and Why Florida Blue Members Choose It

Transcranial Magnetic Stimulation uses focused magnetic pulses to activate mood-regulating brain circuits. Sessions are noninvasive, require no anesthesia, and you can typically drive afterward. Florida Blue’s guideline outlines a 6-week acute phase plus a short taper, with bi-weekly rating-scale tracking to document progress.

Who benefits

Members with severe MDD without psychosis who didn’t improve with medications
Those who experienced medication intolerance or seek a medication-sparing option
Patients who prefer clinic-based, evidence-guided care with objective progress tracking

How we personalize care

Baseline and every-two-weeks symptom scoring (use one scale consistently)
Motor threshold mapping and precise coil placement
Progress-informed adjustments within covered protocol parameters

Pre-Authorization & Cost with Florida Blue

Our coordinators verify your benefits, estimate your cost-share, and submit a complete pre-auth packet (and Lucet forms when applicable). We include diagnostic documentation, medication history (dose/duration or intolerance), rating-scale scores, and the planned FDA-cleared protocol — exactly what reviewers look for.

Benefits check: Eligibility, copays, coinsurance, deductibles
Documentation: Notes and rating-scale data with timelines that match guideline expectations
Authorization: We manage requests and any peer-to-peer or appeal
Scheduling: Once approved, we begin weekday sessions (about 20–25 minutes)

Frequently Asked Questions (Florida Blue)

Does Florida Blue cover TMS for conditions beyond depression?

This guideline focuses on TMS for severe MDD without psychosis. Other indications (e.g., OCD, PTSD, pain, neurologic disorders) are listed as experimental/investigational in this policy, including dTMS for OCD and navigated TMS.

How many sessions are covered?

A standard course is 30 treatments over 6 weeks plus a 3-week taper(3, 2, 1 sessions). Treatment frequencies under 5 days/week are individually reviewed.

Can I repeat TMS if I relapse?

Yes — if you meet initiation criteria again, previously achieved ≥50% improvement on a standardized scale, and at least 90 days have passed since the last course.

Do you help with authorization?

Absolutely. We verify benefits, submit pre-authorization (including Lucet for select products), and keep you updated throughout the process.

Get Florida Blue–Covered TMS in Tampa or Wesley Chapel

We’ll confirm your Florida Blue eligibility, submit pre-authorization, and give you a clear out-of-pocket estimate before your first session.

📞 Call (813) 867-2378 📅 Request a Florida Blue coverage check

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Florida TMS Clinic — Wesley Chapel