Transcranial Magnetic Stimulation for Treatment Resistant Major Depression

This policy covers transcranial magnetic stimulation (rTMS, dTMS, iTBS, e.g., NeuroStar®) for treatment‑resistant, DSM‑confirmed severe major depressive disorder in adults (≥18) with persistent moderately severe-to-severe symptoms (PHQ‑9 ≥15), who have failed or are intolerant of at least two adequate antidepressant trials from different classes and an adequate trial of evidence‑based psychotherapy, with ECT failure or contraindication as applicable. Coverage is limited to FDA‑cleared devices and up to 36 sessions under direct supervision by a psychiatrist trained in TMS, generally excludes those <18 (ages 15–17 reviewed case‑by‑case), excludes schizophrenia/schizoaffective/bipolar diagnoses, prohibits concurrent ketamine/esketamine/infusion therapy, and disfavors treatment when proximate magnetic‑sensitive implants or certain implanted devices are present.

"Initial treatment with rTMS, dTMS, or iTBS for adults aged ≥ 18 years."