All PlansCoverageMedium impact
Tonic Motor Activation (TOMAC) for Restless Legs Syndrome
Regence BlueShield·Neurology, Sleep Medicine, PM&R (Physical Medicine & Rehab)·Coding
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
Effective July 1, 2026, Tonic Motor Activation (TOMAC) for Restless Legs Syndrome is classified as investigational and is NOT covered. Billing teams must deny all TOMAC claims and inform patients they are financially responsible for costs. This is a new policy establishing non-coverage status.
Action Required
By June 30, 2026: Billing team must update system to flag all TOMAC device claims (NTX100 System and related codes) as investigational/non-covered. Add denial reason code to system indicating investigational status per DME83.15. Providers must inform patients in writing BEFORE service delivery that TOMAC is not covered and patient will be financially responsible. Place coverage determination notice in patient file. Update encounter forms and pre-service notification templates. Route all TOMAC inquiries to compliance/clinical team. Failure to obtain patient financial responsibility acknowledgment may result in payment disputes and bad debt exposure.