UnitedHealthcare Coverage for TMS Therapy | Florida TMS Clinic
UnitedHealthcare • Tampa & Wesley Chapel

UnitedHealthcare Coverage for TMS Therapy

Florida TMS Clinic is an in-network provider for UnitedHealthcare/Optum. We verify your benefits, manage pre-authorization, and deliver FDA-cleared TMS for depression — with accessible scheduling and outcome-based care.

📞 Call (813) 867-2378 📅 Request a UHC coverage check Pre-authorization handled for you (Optum)

In-network, outcomes-focused

TMS that fits your UnitedHealthcare plan — and your life

We’re an experienced TMS center serving **Tampa** and **Wesley Chapel** with a comprehensive program: psychiatric evaluation, measurement-based care, FDA-cleared protocols, and collaborative follow-up with your therapist or PCP. Our team submits the authorization packet to Optum, tracks your progress with validated scales, and communicates updates to you and your care team.

  • In-network for UnitedHealthcare / Optum Behavioral Health
  • Measurement-based care(PHQ-9, HAM-D, MADRS) to document improvement
  • Clear expectations on session count, retreatment rules, and documentation
  • Flexible scheduling and quick turnarounds on pre-auth

UnitedHealthcare TMS Coverage: Eligibility & What’s Included

UnitedHealthcare (managed by Optum Behavioral Health) deems TMS proven and medically necessary for adults with major depressive disorder when these conditions are met: :contentReference[oaicite:2]{index=2}

Eligibility checklist

  • Age: 18 or older
  • Diagnosis: Major Depressive Disorder confirmed with a validated scale (e.g., BDI, HAM-D, MADRS) and baseline documented
  • Medication history: Lack of clinically significant response and/or inability to tolerate two antidepressant trials from two different classes in the current episode or prior documented response to TMS (≥50% improvement) in a previous episode
  • Device: Treatment on an FDA-cleared TMS device
  • Ordering clinician: TMS ordered by a psychiatrist; physician oversight required during treatment

See Coverage Rationale & Utilization Management sections. :contentReference[oaicite:3]{index=3}

Session limits & retreatment

  • Course length: Up to 30 treatment sessions, followed by 6 taper sessions
  • Retreatment (effective 01/01/2024): May be considered 6 months after the most recent course if all of the following apply:
    • Initial criteria were met
    • Relapse despite ongoing treatment strategies (e.g., meds, therapy)
    • Prior course achieved ≥50% improvement on a standardized scale

Retreatment criteria and timing are explicitly defined. :contentReference[oaicite:4]{index=4}

What UHC lists as unproven / not medically necessary

  • Accelerated TMS protocols and/or theta-burst stimulation protocols (TBS)
  • Maintenance/booster TMS outside the covered course
  • TMS for conditions where MDD is not the covered focus (e.g., OCD, PTSD) within this policy
  • TMS during acute psychiatric emergencies or in pregnancy/nursing (per current policy language)

Unproven/not medically necessary list summarized from policy. :contentReference[oaicite:5]{index=5}

Coverage always depends on your member-specific benefit plan and any applicable mandates. We verify your benefits and confirm documentation required by Optum. :contentReference[oaicite:6]{index=6}

What TMS Is — and Why UHC Members Choose It

Transcranial Magnetic Stimulation(TMS) uses focused magnetic pulses to stimulate mood circuits in the brain. Sessions are noninvasive, require no anesthesia, and typically allow you to drive afterward. UHC’s policy describes TMS as a six-week acute phase most likely required to achieve improvement, delivered on FDA-cleared devices. :contentReference[oaicite:7]{index=7}

Who benefits

  • UnitedHealthcare members whose depression has not improved with medications
  • Those who experienced side effects that made medications intolerable
  • Patients wanting a medication-sparing, evidence-based option

How we personalize care

  • Baseline and follow-up rating scales every 2 weeks
  • Motor threshold determination and precise coil placement
  • Progress-based adjustments that remain within covered protocols

Pre-Authorization & Cost with UnitedHealthcare

Our coordinators verify your UnitedHealthcare benefits, estimate out-of-pocket costs, and submit a complete pre-auth packet to Optum. We include diagnostic documentation, medication history (dose/duration or intolerance), baseline rating-scale scores, and the planned FDA-cleared protocol.

  1. Benefits check: We confirm eligibility, copays, coinsurance, and deductibles
  2. Documentation: We compile notes and rating-scale data needed by Optum
  3. Authorization: We manage requests, peer-to-peer reviews, and appeals
  4. Scheduling: Once approved, we begin weekday sessions (20–25 minutes)

UHC determines payment from your plan document; codes commonly used include 90867, 90868, 90869. :contentReference[oaicite:8]{index=8}

TMS vs. “accelerated” or theta-burst protocols

UnitedHealthcare currently categorizes accelerated schedules and theta-burst stimulation as unproven/not medically necessary, even though some studies show promise. We’ll always align your care plan with what your plan covers and discuss any non-covered options transparently. :contentReference[oaicite:10]{index=10}

Frequently Asked Questions (UnitedHealthcare)

Does UHC cover TMS for conditions other than depression?

The policy’s covered indication in this guideline is adult Major Depressive Disorder. Other conditions (e.g., PTSD, OCD) are listed under “not medically necessary” in this behavioral policy. Coverage for other diagnoses (such as OCD) may be addressed in separate UHC medical policies. :contentReference[oaicite:11]{index=11}

How many sessions are covered?

Up to 30 treatment sessions plus 6 taper sessions per course, when medical-necessity criteria are met. :contentReference[oaicite:12]{index=12}

Will UnitedHealthcare cover a second course if I relapse?

Retreatment may be considered ≥ 6 months after the most recent course if you met the initial criteria, relapsed despite ongoing treatment, and your prior course achieved ≥50% improvement on standardized scales. :contentReference[oaicite:13]{index=13}

Do you help with authorization?

Yes. We verify benefits, compile documentation, submit pre-authorization to Optum, and handle any peer-to-peer or appeal if needed — keeping you informed at every step.

Get UnitedHealthcare-Covered TMS in Tampa or Wesley Chapel

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

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

Tampa

Florida TMS Clinic — Tampa

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Wesley Chapel

Florida TMS Clinic — Wesley Chapel

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UnitedHealthcare covers TMS for adult Major Depressive Disorder when evidence-based criteria are met. We’ll handle your pre-authorization with Optum.
📞 Call (813) 867-2378 📅 Check my UHC coverage

Florida TMS Clinic

In-network TMS for UnitedHealthcare/Optum in Tampa & Wesley Chapel. Evidence-based depression care with validated outcomes.

Phone: (813) 867-2378

Locations: Tampa · Wesley Chapel