CommercialCoverageMedium impact
Transcranial Magnetic Stimulation (BSC2.19)
Blue Shield of California·CA · Psychiatry, Neurology·Medical Policy
Effective date
May 1, 2026
We identified it
May 1, 2026
Summary
Blue Shield of California updated their Transcranial Magnetic Stimulation (TMS) policy effective May 1, 2026, expanding coverage to include patients age 15 and above (previously adults only) and adding new FDA-cleared modalities including the accelerated SAINT protocol. The policy clarifies coverage criteria for treatment-resistant depression and explicitly states that maintenance TMS therapy is investigational.
Action Required
Before May 1, 2026: Billing teams treating Blue Shield of California members must update TMS coverage criteria to include patients age 15 and above (expanded from adults only). Update prior authorization requests to reflect new coverage criteria including treatment-resistant depression requirements and new FDA-cleared modalities (conventional rTMS, deep TMS, theta burst stimulation, and SAINT protocol). Ensure documentation includes diagnosis of Major Depressive Disorder, age verification, and evidence of treatment resistance or tolerability concerns. Note that maintenance TMS therapy requests will be denied as investigational.