Transcranial Magnetic Stimulation – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare deems transcranial magnetic stimulation (TMS) for all medical (non‑behavioral) conditions — including, but not limited to, Alzheimer’s, epilepsy, chronic neuropathic pain, headaches, Parkinson’s, stroke, tinnitus, TBI, dystonia, navigated TMS for planning/diagnosis, and theta‑burst/accelerated/MRI‑guided protocols — unproven and not medically necessary (excluded). Behavioral indications are covered under a separate Optum Behavioral Clinical Policy, there are no specific documentation requirements in this policy, and coverage is determined by the member’s benefit plan and applicable state/federal mandates (CPT/diagnosis listings or FDA approval do not guarantee coverage).

"Behavioral disorders: Not covered by this policy text — refer to the Optum Behavioral Clinical Policy titled 'Transcranial Magnetic Stimulation' at Optum Provider Express > Clinical Resources > Gui..."