Transcranial magnetic stimulation

Coverage varies depending on plan

Applies to:

Group HMO, EPO, POS and PPO members

Individual MyPriority® HMO, POS and PPO members

Medicare Advantage plan members

Medicaid (Providers are responsible for referring members to their PIHP if they require specialized behavioral health services. Members who are being served through the PIHP system of care are generally not eligible to receive mental health outpatient services through Priority Health.)

Definition

From the Mayo Clinic: Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven't been effective.

TMS medical necessity criteria

The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for TMS, the Priority Health Behavioral Health department relies on InterQual^® Behavioral Health criteria.

TMS authorizations

Authorization is required. Requests must include:

Current Diagnosis
Onset of current depressive episode
Dates of current or recent outpatient therapy
A copy of the depression screening tool completed by the member
Notation of all medication trials that have been completed
Information regarding any medical contraindications

In-network providers

In-network providers can request authorization for TMS using GuidingCare.

Request an authorization

Out-of-network providers

If you're a provider located within the state of Michigan and would like to join our provider network, visit our credentialing application page.

Out-of-network providers request mental health and substance use disorder services using our Transcranial Magnetic Stimulation (TMS) authorization form.