by Sophie Simon and Rose George, MD

As we enter the spring of 2026, many insurance companies are reviewing their coverage policies for TMS, among other healthcare services. With this review there are some updates and expansions of coverage guidelines that will help bring this life-changing treatment to those in need. We help bridge the gap between patient advocacy and insurance communication, so will now give a break down these requirements for anyone who might be considering TMS for themselves or a loved one.

Diagnosis Requirements:

A formal diagnosis of Major Depressive Disorder (MDD, or diagnosis code F33.2) is still one of the main qualifications for TMS.

• Most insurances require a “severe” form of MDD, while United Healthcare and Cigna/Evernorth have expanded coverage to those with “moderate” or “severe” MDD.

Medication Requirements:

• An individual must have tried at least 1 antidepressant medication for a trial period of 6-8 weeks without significant improvement to qualify for coverage under Medicare guidelines.
• All other payers require a trial of at least 2 antidepressant medications from 2 different drug classes to qualify for coverage.

Therapy Requirements:

• Generally, 12 sessions or 3 months of a type of therapy that’s been proven effective for depression is what insurances want to see.
• Cigna/Evernorth and Aetna are currently the only two companies that still have this requirement.
• Medicare, Anthem BCBS, United Healthcare, and Tricare no longer require any amount of therapy to qualify for coverage.

Prior Authorization Requirements:

• Effective March 6th 2026, Cigna/Evernorth will no longer require a prior authorization for TMS. This means that if an individual is determined by a psychiatrist to be a good candidate for TMS, they will not need to wait for any further documentation from Cigna before scheduling a start date.
• Medicare is the only other major insurance that does not require prior authorization for TMS. As of today, all other commercial insurances (with some exceptions for specific high benefit plans) still require clinics to submit a prior authorization request, which can take anywhere between 48 hours to over a week to review and approve.

Age Requirement:

• United Healthcare, Aetna, Cigna, Tricare, and some select Anthem BCBS plans now cover individuals who are 15-17 years old.
• All other insurance plans only cover TMS for those who are 18 or older.

This shows progress for TMS becoming more accessible as time goes on. More insurance companies than ever are not only offering to cover TMS, but they are expanding their definitions of coverage and allowing more people to qualify for TMS than ever before. If you have any further questions about insurance guidelines for TMS, feel free to reach out to us by using the contact page on our website.

Sources:

231 colorado managed care program features, as of 2021 features. medicaid.gov. (2021). https://www.medicaid.gov/medicaid/managed-care/downloads/co-2021-mmcdcs.pdf

EVERNORTH coverage policy: EN0383 1 coverage policy effective date 3/15/2025. provider.evernorth.com. (2025, March 15). https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf

LCD – Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (L34998). (2022). Cms.gov. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=34998

Transcranial Magnetic Stimulation and Cranial Electrical Stimulation – Medical Clinical Policy Bulletins | Aetna. (2015b). Aetna.com. https://www.aetna.com/cpb/medical/data/400_499/0469.html

Transcranial Magnetic Stimulation Optum Behavioral Health Solutions Behavioral Clinical Policy Transcranial Magnetic Stimulation. (2025). In Providerexpress.com. Optum. https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/bcp/tmsMCS.pdf

Tricare. (2026, February 9). February 9, 2026 mental health coverage and requirements 1 of 6. manuals.health.mil. https://tricare.triwest.com/globalassets/tricare/provider/tricare-mental-health-coverage-and-requirements.pdf