You have been told TMS is covered by most insurance, and then you call your plan and hear something very different: prior authorization, step therapy, medical necessity, a list of medications you must have already failed. The short version is that TMS is covered by most major plans for treatment-resistant depression, but only after you meet each carrier’s written criteria. Coverage is rarely a yes or a no. It is a checklist, and knowing the checklist before you start is the difference between approval in a couple of weeks and a denial letter.
This guide explains what insurers actually require, how Aetna, Cigna, Optum (UnitedHealthcare), TRICARE and Medicare differ, what is not covered, how prior authorization works and what you can expect to pay. It uses the carriers’ own published policies where they are available, and it says clearly where details vary by plan. If you want the pricing side first, our TMS therapy cost page covers it, and our complete guide to TMS therapy explains the treatment itself.
| What We Know
Most major commercial plans and Medicare cover a full initial course of TMS, typically 30 to 36 treatments, for treatment-resistant depression once medical necessity criteria are met and prior authorization is approved. Insurers want documentation that goes beyond a diagnosis. Cigna’s 2026 policy, for example, requires failure of at least two antidepressants from two classes, an adequate psychotherapy trial, and depression rating scales at the start and end of treatment. Age and severity rules differ: Aetna, Cigna and Optum cover teens from age 15, while TRICARE and Medicare cover adults only. Village TMS is in network with Aetna, Cigna, Optum, TRICARE East (Humana Military) and Medicare, verifies coverage for free, and reports that most insured patients pay $0 to $50 per session. For other plans, we can request a single case agreement with your insurer, though approval is the insurer’s decision. |
Does insurance cover TMS therapy?
Yes, for most patients with treatment-resistant depression. Medicare and most major commercial insurers cover an initial course of TMS, usually 30 to 36 sessions, when you meet their criteria for diagnosis, prior treatment and safety. Coverage depends on your specific plan, so approval is never automatic, and your out-of-pocket cost depends on your deductible, copay and coinsurance.
That answer holds across carriers because the criteria rest on the same evidence. TMS has been FDA-cleared for depression in adults who did not improve on antidepressants since 2008, and every insurer’s policy is built around that population. What differs is how many medication trials they want to see, whether they require therapy first, and what paperwork proves it.
What do insurers require before approving TMS?
Insurers approve TMS when your records show depression that is severe (Aetna, Optum, TRICARE) or moderate to severe (Cigna) that has not responded to standard treatment and that TMS is safe for you. Exact thresholds vary, but nearly every policy asks for the same five things:
- A confirmed diagnosis of major depressive disorder, usually without psychotic symptoms, made by a psychiatrist
- Documented failure of or intolerance to antidepressant medication, with names, doses, dates and results
- In some plans, including Cigna and Medicare, an adequate trial of evidence-based psychotherapy that did not produce significant improvement
- Validated rating scales such as the PHQ-9, completed before treatment and again at the end of the course
- A screening showing no contraindications, such as a seizure history or implanted metal near the head, and treatment on an FDA-cleared device under a physician’s supervision
If your plan requires therapy and you have not yet tried it, that can be the gap that delays approval. Our mental health support team in NYC can help you document an adequate psychotherapy trial alongside medication management.
Does Medicare cover TMS?
Yes. Medicare covers TMS for adults with major depressive disorder when criteria set by your regional Medicare contractor are met, and it is billed as an outpatient service. In New York, the contractor is National Government Services, whose published coverage policy (L33398) lists several routes to eligibility, along with required steps. Village TMS is in network with Medicare.
Under that policy, an adult with a confirmed diagnosis of major depressive disorder qualifies by meeting one of the following: lack of clinically significant response to psychopharmacologic treatment in the current episode across at least two different agent classes; inability to tolerate two such agents; a history of response to TMS in a previous episode; or current treatment with ECT, where TMS is a less invasive option. The policy also requires a trial of evidence-based psychotherapy without significant improvement, an order from a physician who has examined you, and an FDA-cleared device.
The same policy lists limitations. Medicare does not consider maintenance TMS reasonable and necessary, treats deep TMS for OCD as not covered, and asks for extra caution in patients with seizure history, psychosis, certain neurological conditions or implanted magnetic-sensitive devices. Retreatment can be considered if you improved by more than 50 percent on a prior course and later relapsed. Medicare Advantage plans must cover at least what original Medicare does, though their prior authorization steps and cost sharing can differ.
How does Cigna cover TMS in 2026?
Cigna, through its Evernorth coverage policy effective March 15, 2026, considers an initial regimen of 30 to 36 TMS treatments medically necessary for major depressive disorder when you meet all of its criteria. You can read the full Cigna coverage policy yourself. Here is what it says in plain language:
- You are age 15 or older with moderate-to-severe unipolar major depression, without psychosis
- You have not improved with an adequate course of evidence-based psychotherapy in the current episode. Cigna describes an adequate course as at least one weekly session for at least 12 weeks
- For adults, you have failed two or more antidepressant trials from two separate classes. A failed trial means at least four weeks at an adequate dose with no significant improvement, or documented intolerance or a medical reason you could not take the drug
- For teens 15 to 17, you have failed two antidepressant trials
- Depression rating scales are completed at the beginning and end of each course
Cigna will consider a repeat course for a relapse if you improved by more than 50 percent on the last course and held that improvement for at least two months. It calls TMS used as maintenance therapy not medically necessary, and it classifies accelerated protocols, including theta burst stimulation and the Stanford protocol, as experimental or investigational. TMS for other conditions, such as anxiety alone, ADHD or PTSD, is also listed as not medically necessary. Deep TMS for OCD has its own criteria, which include failure of two or more medication trials and an adequate course of psychotherapy.
Cigna’s policy is one carrier’s version, not a universal rule. It is useful because it shows what a typical thorough policy looks like, and because it makes the documentation burden concrete.
How does Aetna cover TMS?
Aetna’s Clinical Policy Bulletin 0469, last reviewed in July 2026, covers TMS for severe major depressive disorder without psychosis, confirmed by a psychiatrist and documented with a standardized rating scale. Its medication requirements are among the strictest of the plans we work with:
- Age 15 or older
- Adults: an inadequate response to two antidepressants from at least two different classes, each taken for at least eight weeks at the maximally tolerated labeled dose, plus an augmentation trial of at least eight weeks, all in the current episode within the past five years
- Teens 15 to 17: TMS given together with an antidepressant, after two antidepressant trials of at least eight weeks each and either a course of evidence-based psychotherapy or an augmentation trial
- A course of up to 30 sessions plus 6 tapering sessions, with one re-mapping allowed during the course
Aetna includes intermittent theta burst on an FDA-cleared device within covered TMS, but lists accelerated and MRI-guided protocols such as SAINT, maintenance TMS, and TMS for OCD, bipolar disorder, PTSD and anxiety disorders as experimental. It also lists contraindications, including substance misuse in the last 90 days and active suicidality. Retreatment requires at least a 50 percent improvement on the prior course that lasted at least two months, and a repeat course within 60 days of the last one is not covered.
How does Optum (UnitedHealthcare) cover TMS?
For UnitedHealthcare plans, the behavioral health criteria for TMS come from Optum’s Behavioral Clinical Policy on TMS, which applies across Optum’s lines of business unless federal or state rules require otherwise. The 2026 version sets these conditions:
- Age 15 or older since January 1, 2026; before that date, 18 or older
- Adults: no clinically significant response to, or inability to tolerate, two antidepressant regimens from at least two different classes in the current episode
- Teens 15 to 17: no clinically significant response to, or inability to tolerate, two antidepressant regimens in the current episode
- A baseline score on a validated rating scale, an FDA-cleared device, and a qualified psychiatrist (or, in some states, a psychiatric nurse practitioner) to order and supervise treatment
- Up to 30 sessions plus 6 tapering sessions
Optum removed its psychotherapy requirement in 2023. It lists maintenance and booster TMS, accelerated and theta burst protocols, and TMS for OCD, bipolar disorder, PTSD and other conditions as unproven. It also does not cover TMS during pregnancy or nursing, or when acute suicidality, psychosis or another emergency calls for a faster level of care. Retreatment is considered for a relapse six months after the last course in patients who improved by more than 50 percent.
How does TRICARE cover TMS?
TRICARE covers TMS, including deep TMS, for major depressive disorder under the TRICARE Policy Manual, and prior authorization is required. A regional contractor’s policy key summarizing the April 2026 manual lists these criteria:
- Age 18 or older; TMS for anyone under 18 is not covered
- Severe major depressive disorder, documented with a standardized depression rating scale
- Nonresponse, defined as less than 25 percent improvement, to at least two antidepressants from different classes, each at maximally indicated doses for six weeks or more, unless side effects or contraindications prevented it
- Evaluation and treatment by a TRICARE-authorized mental health provider trained in TMS, with up to 36 sessions over 90 days
TMS for other conditions, including bipolar disorder, is not covered, and SAINT is treated as an emerging technology. The policy key does not list a psychotherapy requirement. A repeat course can be covered for a relapse in patients who improved by 50 percent or more before, while a past failure to respond to a full 30-session course counts against approval.
How do Aetna, Cigna, Optum, TRICARE and Medicare compare?
The table below summarizes each plan’s published TMS criteria for depression as of October 2026. Employer plans can add their own rules, so a benefits check on your specific plan still decides.
| Criteria | Aetna | Cigna | Optum (UHC) | TRICARE | Medicare (NY) |
|---|---|---|---|---|---|
| Minimum age | 15 | 15 | 15 (since Jan 2026) | 18 | Adults |
| Severity | Severe | Moderate to severe | Severe (per listed diagnosis codes) | Severe | Major depression (no severity level stated) |
| Adult medication trials | 2 classes, 8+ weeks each, plus 8-week augmentation | 2+ trials, 2 classes, 4+ weeks each | 2 regimens, 2 classes | 2 classes, 6+ weeks each, under 25% improvement | Trials from 2+ classes, or intolerance, or prior TMS response, or current ECT |
| Teens 15 to 17 | 2 trials of 8+ weeks plus therapy or augmentation; TMS with an antidepressant | 2 failed trials | 2 failed regimens | Not covered | Not addressed |
| Psychotherapy required | Not for adults; one option for teens | Yes | No (removed 2023) | Not listed | Yes |
| Course | 30 + 6 taper | 30 to 36 | 30 + 6 taper | Up to 36 over 90 days | Per device protocol |
| Theta burst | Covered on a cleared device | Investigational | Unproven | Not addressed; SAINT emerging | Not addressed |
| Retreatment | 50%+ prior gain held 2 months; not within 60 days | 50%+ prior gain held 2 months | 50%+ prior gain; relapse 6 months after last course | 50%+ prior gain | 50%+ prior gain |
| Other conditions | OCD and others not covered | Deep TMS for OCD with criteria (18+) | OCD and others not covered | Depression only | Deep TMS for OCD not covered |
That is why we do not guess. Village TMS is in network with Aetna, Cigna, Optum, TRICARE East (Humana Military) and Medicare, and our team calls your insurer, pulls the current criteria for your plan and tells you before your first session whether you are likely to qualify. If your plan is not on this list, we can ask your insurer for a single case agreement, an individual arrangement that lets your plan cover your treatment with us on agreed terms. Approval is the insurer’s decision, so we will tell you the outcome before you start. Village TMS does not currently accept Medicaid, including Medicaid managed care plans.
What does insurance usually not cover?
Coverage gaps are fairly consistent across the plans we work with. None of the five covers maintenance TMS, and none covers accelerated protocols such as SAINT. Theta burst is split: Aetna covers intermittent theta burst on an FDA-cleared device, while Cigna and Optum list it as investigational or unproven. TMS for conditions other than depression is generally not covered, with the exception of Cigna’s criteria for deep TMS in OCD. TRICARE does not cover TMS under age 18, and Optum excludes treatment during pregnancy or nursing. These exclusions affect your out-of-pocket cost if you want those options even when your standard course is approved.
If you are curious about shorter schedules, our article on accelerated TMS and the 5-day SAINT protocol explains why coverage lags behind the evidence. And if you are exploring TMS for conditions such as PTSD or ADHD, our pages on TMS for PTSD and TMS for ADHD describe how we approach adjunct care, and our team will tell you honestly what your plan is likely to pay for.
How does prior authorization for TMS work?
Prior authorization means your insurer must approve TMS before you start. The clinic submits your records, the insurer reviews them against its policy, and you receive an approval for a set number of sessions or a denial with reasons. Our team handles the paperwork, but the speed depends on how complete your history is.
A typical sequence looks like this:
- Free consultation and benefits check, where we confirm your plan and its TMS policy
- A psychiatric evaluation that confirms diagnosis, severity and safety for TMS
- Collection of your medication history, including names, doses, start and stop dates and why each was stopped
- Collection of therapy records and baseline rating scales such as the PHQ-9
- Submission of the authorization request, and a response from the insurer that can take days to a couple of weeks
- Scheduling your first session, which includes motor threshold calibration, once approved
If you are a clinician referring a patient, our provider referral page explains what we need to start the process.
What will you actually pay for TMS with insurance?
Your cost is set by your plan’s deductible, copay or coinsurance, not by the treatment. Village TMS reports that most insured patients pay $0 to $50 per session, and we verify your exact cost for free before you start, as described on our TMS therapy page. A standard course of about 36 sessions over roughly six weeks means those per-session amounts add up, so ask for a full-course estimate.
If your plan does not cover TMS or you have not met its criteria, flexible self-pay plans are available, and for out-of-network benefits our team provides documentation to help you seek reimbursement. Ask about all three options in your consultation.
What if your insurance denies TMS?
A denial is usually about missing documentation, not a final answer. Insurers often deny because medication trials were not recorded with doses and dates, because psychotherapy was not documented, or because a rating scale was missing. Your clinic can submit additional records, request a peer-to-peer review between your psychiatrist and the insurer’s reviewer, and file a formal appeal.
If you truly have not tried enough medications yet, the denial is telling you what your plan wants to see first. In that case, a short additional trial under psychiatric supervision may be the fastest path to approval, and your psychiatrist can help you weigh that against how much you are struggling now. Our treatment-resistant depression page explains how that diagnosis is documented and lays out the other options we offer if TMS is not available to you right away.
How should you document your medication history before applying?
Most denials trace back to an incomplete medication history. Before your consultation, write down every antidepressant you have taken for this episode of depression, because insurers want specifics rather than a general statement that nothing worked. Pharmacy records, old prescription bottles and your pharmacy’s printed history can fill gaps your memory leaves.
- The name of each medication and its drug class, such as an SSRI or SNRI
- The highest dose you reached and how long you stayed on it, since plans set different minimums: four weeks for Cigna, six weeks for TRICARE and eight weeks for Aetna
- The start and stop dates, and who prescribed each one
- Why you stopped, whether it was no improvement, side effects or a medical reason you could not continue
- Any augmentation, meaning a second medication added to boost the first
Intolerance counts. Cigna’s policy, for instance, treats a medication with documented intolerance or a medical contraindication as a failed trial, so a drug that caused side effects you could not live with can still support your application when it is recorded properly.
Does the TMS device or provider matter to insurers?
Yes. Insurers generally require treatment on an FDA-cleared device, delivered in an outpatient office under the supervision of a physician with TMS training. Medicare’s New York policy specifies that the treatment follow the manufacturer’s protocol and parameters, with modifications only where the published evidence supports them, and Cigna’s policy requires an FDA-approved device and an appropriately trained clinician. Aetna and Optum allow a psychiatrist or, in some cases, a psychiatric nurse practitioner to order and oversee TMS, and Medicare’s New York policy expects the ordering physician to supervise treatment directly.
In practice, that means you should ask any clinic which device it uses, whether a psychiatrist supervises treatment, and whether it is in network with your plan. A clinic that is out of network can still be an option, but your reimbursement rules will be different and your cost can change substantially.
Do you have to keep taking your medication during TMS?
Usually you continue your current treatment unless your psychiatrist advises otherwise. The National Institute of Mental Health notes that brain stimulation treatment plans typically include psychotherapy, medication or both, and that patients should not stop any treatment unless a health care provider specifically advises it. This is also useful for insurance, because ongoing treatment shows your plan that TMS is part of a comprehensive approach rather than a substitute for care.
Does insurance cover TMS for teens and older adults?
Coverage depends on age as well as diagnosis. Aetna, Cigna and Optum cover TMS from age 15 when their adolescent criteria are met: Aetna requires TMS to be given together with an antidepressant after two eight-week trials, Cigna asks for two failed antidepressant trials, and Optum asks for two failed regimens. TRICARE covers adults 18 and older only, and Medicare’s policy applies to adults. The FDA has cleared TMS as an add-on treatment for depression in adolescents 15 and older. If you are seeking TMS for a teenager, expect the plan to review the case more closely, and ask the clinic about its experience with adolescent treatment before you apply.
Is Spravato or ketamine covered the same way?
No. Spravato is FDA-approved and given in-clinic, which is why it is more often covered than IV or IM ketamine, which are used off-label and are frequently self-pay. If you want the details, see our Spravato NYC page, our guide to ketamine insurance coverage and our upcoming breakdown of Spravato cost. For a comparison of effectiveness across treatments, our TMS success rate article is a good starting point.
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