TMS AETNA

Aetna Transcranial Magnetic Stimulation Therapy Coverage Policy

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 2 antidepressants and augmentation therapy

Below are the details of Aetna’s TMS therapy coverage policy in 2023.

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
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