Medicare AdvantageCoverageMedium impact
MA07.035f, Therapeutic Transcranial Magnetic Stimulation (TMS)
Independence Blue Cross·Psychiatry, Neurology·Medical Policy
Effective date
Dec 25, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA07.035f to MA07.035g, expanding TMS coverage to include adolescents ages 15 and older (previously adult-only) and adding NeuroStar Advanced Therapy as an FDA-approved adjunct for adolescent MDD. The policy now includes specific examples of required medication trial drug classes (SSRIs, SNRIs, TCAs, MAOIs, and others) and standardized rating scales for measuring depressive symptoms. Documentation requirements and clinical criteria remain largely unchanged.
Action Required
By December 25, 2025: (1) Billing team must update billing system to allow TMS claims (CPT 90867, 90868, 90869, 0889T) for patients ages 15+ (previously restricted to adults 18+). (2) Providers ordering TMS must document medication trial history using the specified drug classes listed in policy (SSRIs, SNRIs, TCAs, MAOIs, Other Antidepressants, Augmentation agents). (3) Prior authorization reviewers must validate that patients ages 15-21 meet criteria for NeuroStar Advanced Therapy or other FDA-approved TMS modalities. (4) Update encounter forms and clinical documentation templates to capture patient age range and document specific medication trial attempts with adequate dosing/duration. (5) Verify no absolute contraindications (magnetic-sensitive implants within 30 cm) are present before authorization. Failure to update age criteria may result in denial of claims for qualifying adolescent patients.