Does Cigna Cover Transcranial Magnetic Stimulation (TMS)?
Yes, Cigna insurance covers Transcranial Magnetic Stimulation (TMS) when TMS therapy is medically essential, and the patient meets all required criteria.1 Your Cigna TMS coverage details will depend on your specific insurance policy.
Jump to Section
- Does Cigna Cover Transcranial Magnetic Stimulation (TMS)?
- How to Verify Cigna Coverage for TMS Therapy
- Cigna TMS Coverage Eligibility Policy
- What is Transcranial Magnetic Stimulation?
- How Much Does TMS Cost Without Insurance?
How to Verify Cigna Coverage for TMS Therapy
Athena Care has multiple TMS clinics in Tennessee. We are also in-network with most major insurance plans. Therefore, filling out our free and confidential online insurance verification form is the most reliable method to start your Cigna TMS therapy today.
Let our highly experienced, knowledgeable care coordinators handle the challenges of contacting your insurance carrier for more information about Cigna TMS treatment. After you submit the form, a care coordinator will review your policy and clearly explain your options. Any information you provide or discuss will remain confidential.
Cigna TMS Coverage Eligibility Policy
The Cigna TMS guidelines are as follows:
When a person meets all of the following requirements, a Transcranial Magnetic Stimulation (TMS) first regimen (i.e., 30-36 treatment sessions) delivered in an outpatient setting utilizing a United States Food and Drug Administration (FDA) approved device is deemed medically necessary:
- 18 years of age or older
- A diagnosis of moderate-to-severe Major Depressive Disorder (MDD), single or recurrent episode or acute relapse, without psychosis, as per the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
- The current depressive episode meets all of the following criteria:
- The failure of two or more antidepressant medications from two different antidepressant drug classes. An unsuccessful trial is one used for at least four weeks at therapeutic levels with no discernible improvement in depression symptoms or one that has a known medical contraindication or intolerance.
- An appropriate trial of evidence-based psychotherapy recognized to be beneficial in the treatment of MDD does not result in a discernible reduction in depressed symptoms
- The initial and each successive course of TMS therapy is preceded by the administration of validated depression monitoring scales
When all of the following conditions are satisfied, repeat TMS therapy (i.e., 30-36 treatment sessions) conducted in an outpatient setting for a repeated or acute relapse of MDD is deemed medically necessary:
- Before the initial course of TMS, the patient had to meet all the requirements for initial TMS therapy
- The individual has at least a 50% improvement on one or more standard depression rating scales
- Demonstrated improvement for at least two months after the initial course of TMS treatment
Transcranial Magnetic Stimulation is regarded as experimental, investigational, or untested for any other indication, including but not limited to migraine headaches.
What is Transcranial Magnetic Stimulation?
Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that delivers magnetic pulses to the brain in patients with Treatment Resistant Depression (TRD) and other psychiatric and neurologic illnesses.
A qualified mental health professional applies a small coil to the scalp, which generates a rapidly alternating current. The magnetic field produced by the electrical current induces neural activation by penetrating the scalp and bone without obstructing it.
TMS therapy treatment is not available to people with certain medical implants. Metal implants or gadgets that interact with magnetic fields can cause complications. In addition, you may not be eligible for TMS therapy if you have stents, implanted stimulators, a pacemaker, a medicine pump, cochlear implants, or gunshot fragments in your body. Discussing these concerns with your doctor before TMS therapy is critical to avoid adverse side effects.
Additionally, people with certain medical issues should not receive TMS. For instance, people who have a history of seizures, those who have bipolar disorder, or those who are pregnant should avoid this therapy.
Finally, inform your TMS clinician about any prescription or over-the-counter medications, supplements, or vitamins you’re taking, as certain drug combinations can cause serious complications.
How Much Does TMS Cost Without Insurance?
The following are average costs for TMS therapy without Cigna TMS coverage or other insurance. These costs may vary by location and other factors. Furthermore, they may not reflect the actual cost of treatment or what you may pay in Tennessee.
TMS sessions typically cost between $400 and $500 per session.2 The overall price of TMS therapy may be around $15,000 because most patients need numerous sessions to acquire optimal results.
- “Transcranial Magnetic Stimulation.” Cigna, static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0383_coveragepositioncriteria_transcranial_magnetic_stimulation.pdf. Accessed 9 July 2022.
- Porter, Robert. “What Does TMS Therapy Cost? TMS Information | BetterHelp Advice.” Betterhelp, BetterHelp, 20 Apr. 2022, www.betterhelp.com/advice/therapy/how-much-does-tms-therapy-cost
If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.
One of our friendly associates will help you get the help you need. Take this first step to feel better and take control.