CommercialCoverageMedium impact
Transcranial Magnetic Stimulation and Cranial Electrotherapy Stimulation 3.01.09
Excellus BlueCross BlueShield·Psychiatry·Behavioral Health (Psychiatry/Psychology)
Effective date
Jan 22, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their TMS (Transcranial Magnetic Stimulation) policy effective January 22, 2026, establishing specific coverage criteria for Major Depressive Disorder and Obsessive-Compulsive Disorder treatment. The policy requires documented failure of both psychotherapy and multiple medication trials before TMS is considered medically appropriate.
Action Required
By January 22, 2026: Billing team must update prior authorization requirements for TMS treatments. Ensure providers document all required criteria including: failed psychotherapy trials, failed medication trials (2+ antidepressants for adults, plus 1 augmentation trial), standardized depression/OCD rating scales, and absence of contraindications. Update encounter forms and EMR templates to capture required documentation elements. Claims without complete documentation will be denied.