CommercialCoverageMedium impact
Repetitive Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders (BSC2.19)
Blue Shield of California·CA · Psychiatry, Neurology·Medical Policy
Effective date
Oct 1, 2025
We identified it
Aug 1, 2025
Summary
Blue Shield of California updated their rTMS policy for treating depression, clarifying coverage criteria including required medication failures and psychotherapy trials. The policy becomes effective October 1, 2025, and specifies that maintenance rTMS and treatment for other psychiatric/neurologic conditions remain investigational.
Action Required
Before October 1, 2025: Billing team must update prior authorization requirements for rTMS procedures to ensure documentation includes: 1) Standardized depression rating scales showing moderately-severe to severe Major Depressive Disorder, 2) Evidence of inadequate response to 2 antidepressants from different classes OR 1 antidepressant plus 1 adjunctive medication OR inability to tolerate 2 different antidepressants, 3) Documentation of failed adequate psychotherapy trial (8-12 sessions of CBT or IPT) unless patient has history of positive rTMS response. Update encounter forms to remind providers of these documentation requirements for Blue Shield of California members.