If you’ve been struggling with depression or obsessive-compulsive disorder (OCD) and haven’t found relief through traditional treatment, transcranial magnetic stimulation (TMS) therapy may be a next step worth exploring. TMS is an FDA-approved, non-invasive treatment that uses gentle magnetic pulses to stimulate areas of the brain involved in mood regulation.
One of the most common questions we get here at BestMind is: “Does insurance cover TMS therapy?” Today, we’ll explore Cigna insurance coverage for TMS therapy. The good news is that Cigna does offer coverage for TMS therapy, including for major depressive disorder and OCD, as long as you meet specific criteria.
In this blog post, we’ll walk you through what TMS therapy is, the exact requirements needed for Cigna to approve coverage, and other frequently asked questions.
What is TMS therapy?
Transcranial magnetic stimulation (TMS) therapy is a non-invasive treatment that uses targeted magnetic pulses to stimulate areas of the brain involved in mood regulation. It’s primarily used to treat major depressive disorder (MDD), especially when other treatments like medication and talk therapy haven’t worked (also known as treatment-resistant depression).
There are two main forms of TMS:
- Repetitive TMS (rTMS): This is the most common type, delivering repeated magnetic pulses to the dorsolateral prefrontal cortex (DLPFC), an area of the brain often underactive in people with depression. rTMS involves placing a figure-8 shaped coil on the scalp and using pulses to stimulate neurons and rebalance brain activity.
- Deep TMS (dTMS): This type of TMS uses an H-coil inside a helmet to reach deeper parts of the brain. It stimulates a larger area and may be used for different mental health conditions or some treatment-resistant cases.
TMS doesn’t involve medication, anesthesia, or sedation. Patients remain awake during treatment and can typically resume daily activities right after. A typical session lasts about 20 to 40 minutes, and a full course of treatment usually includes sessions administered five days a week for 4 to 6 weeks, depending on a person’s needs.
One of the main benefits of TMS is that it’s well tolerated with minimal side effects. However, some people may experience mild effects such as headaches, scalp discomfort, or lightheadedness. More serious side effects, like seizures, are extremely rare and occur in about 1 in every 10,000 sessions.
TMS is different to electroconvulsive therapy (ECT). It does not induce seizures and does not require any recovery time.
Read More: TMS vs. ECT: Which is better?
What is TMS therapy FDA-approved to treat?
TMS is currently FDA-approved to treat several mental health and neurological conditions, including:
- Major depressive disorder (MDD): TMS is most commonly used to treat adults with treatment-resistant depression, when at least two antidepressant medications have failed to deliver results.
- Obsessive-compulsive disorder (OCD): dTMS is FDA-approved for individuals with moderate to severe OCD who haven’t responded well to therapy or medication.
- Smoking cessation: TMS is also approved as an aid in quitting smoking, with studies showing improvements in reducing nicotine cravings and cigarette consumption.
- Migraine prevention: Some TMS devices are approved to treat and prevent migraine headaches.
Other uses of TMS – like for anxiety, post-traumatic stress disorder (PTSD), or chronic pain – are currently considered off-label.
Read More: TMS for Migraine: Benefits, Effectiveness, Precautions
Does Cigna cover TMS therapy?
Yes, Cigna covers TMS therapy for certain mental health conditions including major depressive disorder and obsessive-compulsive disorder. Here’s what you need to know about Cigna coverage for TMS therapy.
Cigna TMS coverage for major depressive disorder
Cigna considers an initial course of 30 to 36 TMS sessions medically necessary for moderate to severe unipolar depression (without psychosis) when all the following criteria are met:
- The individual is aged 15 or older (see: TMS therapy for teens)
- Diagnosis of major depressive disorder (single or recurrent episode) is confirmed by DSM criteria
- There has been no significant improvement after a trial of evidence-based psychotherapy
- Standardized depression rating scales, like PHQ-9, are used at the start and end of treatment
- Antidepressant medications have failed to deliver results:
- For adults (18+), this means two medications from different classes have not worked
- For adolescents (15-17), this means a failure of at least two trials
- Failed trials include not seeing improvements after 4 weeks at a therapeutic dose, or having a documented contraindication or intolerance to medication.
To be covered by Cigna for TMS therapy, you need to provide thorough documentation of your treatment history and symptom severity. Our team at BestMind can help you gather the necessary documents you need to approve coverage.
Cigna also covers repeat courses of TMS (30 to 36 sessions) for those with a recurrence or relapse of major depression, as long as:
- There was a 50% or more improvement in symptoms at the end of the previous course (based on standardized depression rating scales)
- The improvement lasted at least two months before symptoms returned.
Cigna TMS coverage for obsessive-compulsive disorder (OCD)
Cigna covers deep TMS (dTMS) for OCD when all the following criteria are met:
- The individual is aged 18 or older
- There is a DSM-confirmed diagnosis of OCD
- Two medications have been prescribed for OCD, taken at adequate doses for 8 weeks, and failed to deliver results
- Evidence-based psychotherapy (such as CBT with exposure and response prevention) has been attempted and failed to improve symptoms
- The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is used at the start and end of treatment.
In some cases, individuals may be approved for repeat coverage of dTMS for OCD if:
- There was a 30% or greater improvement in OCD symptoms based on the Y-BOCS
- The improvement lasted for at least two months after treatment.
Keep Reading: TMS for OCD: Evidence, Side Effects, Benefits, and What to Expect
What Cigna doesn’t cover
Cigna doesn’t cover:
- Maintenance TMS therapy: Such as ongoing or open-ended treatments
- TMS for non-approved conditions: Such as migraine headaches, where it’s not considered medically necessary
- Accelerated TMS: Including Theta Burst Stimulation (TBS), Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), and Stanford Neuromodulation Therapy (SNT), all of which are considered experimental, investigational, or unproven.
See: What Makes SAINT TMS Different From Regular TMS?
How to get insurance coverage for TMS therapy
Getting insurance coverage for TMS therapy can feel complicated, but it doesn’t have to be! If you’re considering TMS and have Cigna health insurance (or another major provider), here are the steps you need to take for approval:
1. Start with a diagnosis
First things first. To qualify for insurance coverage, you’ll need a formal diagnosis from a licensed provider. For Cigna, TMS is mostly covered for:
- Moderate to severe major depressive disorder without psychosis
- Obsessive-compulsive disorder (dTMS).
The diagnosis must be based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and supported by clinical evaluation. If you don’t yet have a diagnosis, contact us now for a consultation.
During your TMS consultation, we’ll assign you a TMS coordinator who will be responsible for gathering all the information needed to perform an insurance benefits investigation. This might involve contacting Cigna to review mental health benefits and projected out-of-pocket costs.
2. Document previous treatment attempts
Cigna requires documentation showing that you’ve tried previous treatments unsuccessfully:
- For depression, you need to show you’ve tried at least two antidepressant medications from different drug classes for at least four weeks, as well as a round of evidence-based psychotherapy
- For OCD, you need to show you’ve tried two or more medications for at least eight weeks, plus a trial of therapy with exposure and response prevention (ERP).
Make sure your mental health provider has records of these attempts, including dosage, duration, and your response to treatments. This step can sometimes be tricky as it might involve retrieving records from past providers, but our team will work with you to make sure you have all the documentation you need.
3. Use a standardized rating scale
Cigna requires the use of standardized assessment tools before and after TMS treatment to measure your improvement in symptoms. For depression, this is the PHQ-9, and for OCD it’s Y-BOCS. We’ll handle this step as part of your evaluation process.
4. Get a preauthorization
Once your provider has confirmed that TMS is appropriate for you, they’ll submit a preauthorization request to Cigna. This is a detailed report that supports the treatment as being medically necessary. It includes information like:
- Your diagnosis
- Treatment history
- Medical necessity documentation
- Planned course of TMS therapy (usually 30 to 36 sessions).
At BestMind, our team handles the preauthorization process for you. We work directly with Cigna to make sure all documentation is submitted correctly and on time, so it’s one less thing for you to worry about.
5. Check your out-of-pocket costs
Even with coverage, there can sometimes be co-pays, deductibles, or co-insurance depending on your individual plan. This might mean you’ll need to pay for part of the treatment yourself.
We’ll help you understand any financial responsibilities before you begin treatment, so there are no unexpected surprises down the line.
FAQs: Cigna insurance coverage for TMS therapy
Below are some frequently asked questions about Cigna coverage for TMS therapy.
Does Cigna Insurance cover TMS therapy for depression?
Yes, Cigna covers transcranial magnetic stimulation (TMS) for moderate to severe major depressive disorder (MDD) when other treatments, like medication and therapy, haven’t worked in the past.
To receive coverage for TMS, patients must meet specific criteria, including a history of trying antidepressants and evidence-based psychotherapy without improvement in symptoms.
Does Cigna cover TMS for OCD?
Yes, Cigna covers deep TMS (dTMS) for people diagnosed with obsessive-compulsive disorder who haven’t responded to at least two medications and evidence-based psychotherapy.
To be eligible for coverage, patients must be 18 years or older, have tried medications for at least eight weeks, and track their progress using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
What does Cigna consider a ‘failed’ antidepressant trial?
According to Cigna, a failed medication trial means either:
- The medication was taken at a therapeutic dose for at least four weeks with no significant improvement, or
- The patient was unable to tolerate the medication due to side effects or a documented medical contraindication.
How many TMS sessions does Cigna cover?
Cigna generally covers an initial course of 30 to 36 TMS sessions delivered over several weeks. They may also cover a repeat course for relapse or recurrence if the previous TMS treatment was successful and symptoms sustained improvement for at least two months.
Does Cigna cover TMS as a maintenance treatment?
No, maintenance TMS therapy is currently considered not medically necessary by Cigna and is not covered.
Does Cigna cover accelerated TMS?
No, Cigna does not currently cover accelerated forms of TMS, like TBS, SAINT, or SNT. Even though accelerated TMS therapy shows promise in research, Cigna requires more long-term data before approving it for coverage.
How do I know if I qualify for TMS coverage with Cigna?
The best way to find out is to speak with your provider. At BestMind, our team can review your treatment history and work directly with Cigna to determine your eligibility and next steps.
Does Cigna cover repeat TMS courses for depression?
Yes, Cigna covers repeat courses of TMS therapy for depression if:
- The patient shows a 50% or more improvement in depressive symptoms after the previous TMS treatment (measured by the PHQ-9 scale)
- The benefits of the previous treatment lasted at least two months before symptoms returned.
Does Cigna cover repeat TMS courses for OCD?
Yes, Cigna covers repeat courses of dTMS for OCD if:
- The patient shows at least a 30% improvement in OCD symptoms (measured by the Y-BOCS)
- The benefits of the previous treatment were maintained for at least two months.
Explore TMS therapy
TMS therapy can be a life-changing treatment, and thanks to growing recognition from insurers like Cigna, it’s now accessible to more people than ever. We understand that navigating insurance coverage can feel complicated, and that’s why our team is here to help you every step of the way.
From verifying your Cigna benefits to handling preauthorization and documentation, we aim to make the process as smooth and stress-free as possible. If you’re considering TMS therapy and want to know if you qualify, contact our team today to discuss your coverage.
