Transcranial Magnetic Stimulation (TMS Therapy) is a non-invasive procedure that uses magnetic pulses to stimulate neurons in the brain to improve symptoms of depression, anxiety, OCD, and PTSD. TMS is generally offered as an option to patients after they have tried one or two antidepressant medications without any clinical benefit. At the time of writing this (April 2023), TMS therapy is FDA approved for Major Depressive Disorder (MDD), Bipolar Depression, Smoking Cessation, Obsessive Compulsive Disorder (OCD), and migraines. However, insurance companies for the most part only cover treatment for MDD and OCD.
Cigna is no different. Cigna’s mental health benefits are “carved out” to a subsidiary organization called Evernorth. If your insurance card says Cigna, Evernorth, or you know for a fact that your mental health benefits utilize the Cigna or Evernorth network, this blog will cover the criteria for TMS coverage.
Does Cigna Cover TMS Therapy For Depression?
It depends. According to Cigna’s coverage policy, 36 sessions of TMS will likely be covered for the treatment of Major Depressive Disorder when all of the following criteria are met:
- The device in question is FDA Approved.
- The patient is 18 or older.
- The individual has a diagnosis of MDD confirmed by a standardized diagnostic tool, and the same tool will be used at the end of treatment
- The individual has failed to achieve satisfactory improvement from at least two adequate trials of antidepressant medications from at least two different classes, each used for a minimum of four weeks
- The individual has failed to achieve satisfactory improvement from psychotherapy
Does Cigna Cover Additional Courses of TMS Therapy For Depression?
If someone had benefited from TMS in the past, but the effects have worn off, Cigna will still cover TMS therapy for depression. However, the criteria is different. This time, the individual needs to meet all of the above criteria for an initial TMS series, plus have had a 50% or greater improvement from their initial TMS course. This improvement is measured on rating scales, so for instance if someone scored a “21” on a PHQ9 before TMS and then a “10” after TMS, Cigna will cover their additional TMS course. However, if that score only decreased to “13,” for example, the request for coverage might be denied. Additionally, Cigna requires that the benefits for TMS lasted at least 2 months post-treatment.
Does Cigna Cover TMS Therapy For OCD?
Again, it depends. The coverage policy is similar to the policy for Major Depressive Disorder, but there are some key differences:
- The device in question is FDA Approved.
- The patient is 18 or older.
- The individual has a diagnosis of OCD confirmed by the YBOCS, which will be used at the end of treatment
- The individual has failed to achieve satisfactory improvement from at least two adequate trials of antidepressant medications from at least two different classes, each used for a minimum of eight weeks
- The individual has failed to achieve satisfactory improvement from psychotherapy
The major difference in TMS coverage for OCD is that each antidepressant trial needs to be tried for a minimum of eight weeks, compared to four weeks for MDD.
Does Cigna Cover Additional Courses of TMS Therapy For Obsessive Compulsive Disorder?
Yes, Cigna will cover additional TMS courses of TMS for OCD as long as the patient meets the above criteria, plus has shown at least a 30% decrease in YBOCS scores compared to when they first started TMS. Additionally, as with MDD, the benefits must have been maintained for at least 2 months before the patient relapsed.
TMS therapy can be a life changing treatment for some people with depression who have not responded to other options, but not all types of TMS are covered by insurance, such as Accelerated TMS. Bespoke Treatment is unique in that all of our offices are in-network with Cigna, and our IOP is in-network with Cigna as well. Even if you think your insurance might not cover TMS, you are welcome to give our office a call to discuss what your options are. We are always here for you.
