MedicaidPrior AuthMedium impact
Transcranial Magnetic Stimulation (TMS) - MEDICAID - LOUISIANA (Revised)
Humana·LA · Psychiatry, Neurology·Medicaid
Effective date
May 18, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid in Louisiana has established new coverage criteria for Transcranial Magnetic Stimulation (TMS) for treating major depressive disorder, effective May 18, 2026. The policy requires psychiatrist referral, prior authorization, and specific failure/intolerance criteria for antidepressants, while excluding maintenance therapy and other diagnoses.
Action Required
Before May 18, 2026: Billing team must implement prior authorization requirements for TMS services for Humana Medicaid Louisiana members. Update system to verify psychiatrist referral is submitted before treatment, confirm patient meets antidepressant failure/intolerance criteria (4 trials from at least 2 classes), and verify no contraindications exist. Train providers on documentation requirements including PHQ-9 scores for retreatment eligibility.