|Highmark Commercial Medical Policy - Delaware|
|Topic:||Transcranial Magnetic Stimulation (TMS)|
|Effective Date:||March 6, 2017|
|Issue Date:||March 6, 2017|
|Last Reviewed:||February 2017|
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
|Policy Position Coverage is subject to the specific terms of the member’s benefit plan.|
Repetitive transcranial magnetic stimulation (rTMS) of the brain may be considered medically necessary as a treatment of major depressive disorder when ALL of the following conditions have been met:
rTMS should be performed using an FDA-cleared device in appropriately selected patients, by a physician who is adequately trained and experienced in the specific techniques used.
A treatment course should not exceed 5 days a week for 6 weeks (total of 30 sessions), followed by a 3-week taper of 3 TMS treatments in week 1, 2 TMS treatments the next week, and 1 TMS treatment in the last week.
All of the following must be present for the administration of rTMS and documented in the medical record and available upon request:
rTMS for major depressive disorder that does not meet the criteria listed above is considered experimental/investigational and therefore, not covered. There is insufficient evidence in medical literature to support the effectiveness of this procedure.
Continued treatment with rTMS of the brain as maintenance therapy is considered experimental/investigational and therefore, not covered. There is insufficient evidence in medical literature to support the effectiveness of this procedure.
Transcranial magnetic stimulation of the brain is considered experimental/investigational and therefore not covered for any other indication. There is insufficient evidence in medical literature to support the effectiveness of this procedure.
|Place of Service: Outpatient|
Experimental/Investigational (E/I) services are not covered regardless of place of service.
Transcranial Magnetic Stimulation is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.
|The policy position applies to all commercial lines of business|