CommercialCoverageMedium impact
07.03.22g, Therapeutic Transcranial Magnetic Stimulation (TMS)
Independence Blue Cross·Psychiatry, Neurology, Pediatrics·Medical Policy
Effective date
Dec 25, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated TMS policy 07.03.22g to 07.03.22h, expanding coverage to adolescents ages 15 and older (previously adult-only) following FDA approval of NeuroStar Advanced Therapy for this population. The policy now includes specific medication class examples, updated literature for OCD and adolescent MDD, and revised policy numbering to MA07.035f. Coverage criteria and clinical requirements remain substantially the same but now explicitly include adolescent treatment pathways.
Action Required
By December 25, 2025: Billing team must update system documentation to reflect policy number change from 07.03.22g to MA07.035f in all TMS authorization and billing workflows. Verify that eligibility and prior authorization systems can process claims for adolescent patients ages 15-21 with severe MDD using CPT codes 90867, 90868, 90869, and 0889T. Update clinical documentation templates and prior authorization request forms to include medication trial requirements from the expanded drug class list (SSRIs, SNRIs, TCAs, MAOIs, other antidepressants, and augmentation agents). Train billing and clinical staff that adolescent patients must still meet all standard criteria including documented medication treatment resistance, documented psychotherapy attempts, and absence of contraindications. Ensure ICD-10 codes F32.2 and F33.2 are properly linked to adolescent age requirements in system validation rules. Verify that CPT 0889T for personalized theta-burst mapping is included in coverage determinations. Update internal policy documentation and remove references to 07.03.22g. Failure to update systems may result in denial of claims for eligible adolescent patients or processing delays due to policy version mismatch.