Medicare AdvantageCoverageMedium impact
MA07.035h, Transcranial Magnetic Stimulation (TMS)
Independence Blue Cross·Psychiatry·Medical Policy
Effective date
Oct 19, 2026
We identified it
Oct 20, 2026
Summary
Independence Blue Cross updated Medicare Advantage policy MA07.035h effective 10/19/2026 to clarify TMS treatment duration, tapering schedules, and coverage criteria. Key changes: multiple daily TMS sessions are now covered only under the SAINT protocol; SAINT/iTBS criteria were updated to define covered treatment days and target development requirements; and target development services (CPT 0889T) are now explicitly included in initial SAINT treatment costs.
Action Required
Already effective 2026-10-19: Billing team must verify implementation of the updated TMS coverage policy for Independence Blue Cross Medicare Advantage members. Confirm current applicability of the following changes: (1) Update billing system logic to restrict multiple daily TMS sessions (CPT 90868, 90869) to SAINT protocol only; (2) Verify that target development services (CPT 0889T) are being bundled with initial SAINT treatment and not billed separately; (3) Ensure prior authorization submissions for TMS include documentation of updated SAINT/iTBS treatment day criteria and target development requirements; (4) Train providers on the clarified standard TMS treatment duration and tapering schedule per the revised policy. Flag any claims submitted since 10/19/2026 using multiple daily sessions outside the SAINT protocol for potential rework. Contact Independence Blue Cross provider services if the practice requires detailed guidance on the updated SAINT/iTBS coverage parameters.