CommercialBilling CodesMedium impact
07.03.22h, Therapeutic Transcranial Magnetic Stimulation (TMS)
Independence Blue Cross·Psychiatry, Neurology·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated TMS policy 07.03.22h effective 01/01/2026 to add two new CPT codes (0997T, 0998T) for personalized target development and accelerated theta-burst stimulation. The policy clarifies specific behavioral health criteria for TMS coverage in treatment-resistant major depressive disorder, requiring documentation of medication resistance, intolerance, or prior TMS response using standardized rating scales.
Action Required
Before 01/01/2026: (1) Billing team must update billing software and fee schedules to recognize CPT codes 0997T and 0998T for TMS procedures. (2) Providers must update encounter documentation templates to capture required criteria: confirmed severe MDD diagnosis with standardized rating scale scores (PHQ-9, BDI, MADRS, GDS, QIDS, HAM-D, or IDS-SR); evidence of medication resistance (≥4 failed trials from ≥2 drug classes) OR intolerance (4 trials with distinct side effects from ≥2 classes) OR prior TMS response (>50% improvement on rating scale with ≥3 month relapse); or evidence-based psychotherapy trial. (3) Create prior authorization checklist requiring documentation of exclusion criteria (no pregnancy, seizure disorder, active psychosis, or active substance use disorder). (4) Train billing and clinical staff on new codes and expanded TMS modalities covered (conventional TMS, deep TMS, theta-burst stimulation). Failure to document medical necessity per these criteria will result in claim denials.