Transcranial magnetic stimulation is considered experimental/investigational and therefore, not eligible for payment for any condition. There is insufficient evidence in medical literature to support the effectiveness of this procedure. The data are insufficient to permit scientific conclusions regarding the role of transcranial magnetic stimulation in the treatment of any condition, including depression. A participating, preferred, or network provider can bill the member for the denied service.

Description

Transcranial magnetic stimulation (TMS) is a method of  noninvasive stimulation of the brain through a small coil placed over the scalp. A rapidly alternating current is then passed through the coil wire, producing a magnetic field that passes unimpeded through the scalp and bone, resulting in electrical stimulation of the cortex. TMS was initially used to investigate nerve conduction. For example, TMS over the motor cortex will produce a contralateral muscular-evoked potential. This “motor threshold” (MT), which is the minimum intensity of stimulation required to induce a motor response, is empirically determined for each individual by gradually increasing the intensity of stimulation. TMS has been investigated as a treatment for major depressive disorders that are resistant to treatment. It is also being tested as a treatment for other disorders including, but not limited to, schizophrenia, obsessive-compulsive disorder, and bulimia.

NOTE:

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.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

02/2011, Transcranial magnetic stimulation considered investigational

O’Reardon J, Solvason H, Janicak P, et. al. Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biol Psychiatry. 2007;62:1208-1216.

Avery D, Isenberg K, Sampson S. Transcranial Magnetic Stimulation in the Acute Treatment of Major Depressive Disorder: Clinical Response in an Open-Label Extension Trial. J Clin Psychiatry. March 2008;69(3):441-451.

Lisanby S, Husain M, Rosenquist P, et al. Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial. Neuropsychopharmacology. 2009;34:522-534.

Demitrack M, Thase M. Clinical Significance of Transcranial Magnetic Stimulation (TMS) in the Treatment of Pharmacoresistant depression: Synthesis of Recent Data. Psychopharmacology Bulletin. 2009;42(2):5-38.

National Guideline Clearinghouse. Depression. The treatment and management of depression in adults.

Tice J, Feldman M. Repetitive Transcranial Magnetic Stimulation for Treatment Resistant Depression. California Technology Assessment Forum. June 17, 2009.

George M, Lisanby S, Avery D. Daily Left Prefrontal Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder. Arch Gen Psychiatry. 2010;67(5):507-516.

Slotema C, Blom J, Hoek H, Sommer I. Should We Expand the Toolbox of Psychiatric Treatment Methods to Include Repetitive Transcranial Magnetic Stimulation (rTMS)?  A Meta-analysis of the Efficacy of rTMS in Psychiatric Disorders. J Clin Psychiatry. 2010;E1-E13.

Janicak P, Nahas Z, Lisanby. Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depressions assessment of relapse during a 6-month, multisite, open-label study. Brain Stimulation. August 2010.

Gelenberg A, Freeman M, Marlowitz J, et al. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Am J Psych Supp. October 2010;167(10):1-152.

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Psychiatric Publishing 2010. Printed November 23, 2010. www.psychiatryonline.com

Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (tms) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012 Jun 11. doi:10.1002/da.21969. [Epub ahead of print]

Balconi M, Ferrari C. rTMS stimulation on left dlpfc affects emotional cue retrieval as a function of anxiety level and gender. Depress Anxiety. 2012 Jun 11. doi:10.1002/da.21968. [Epub ahead of print]

Mantovani A, Pavlicova M, Avery D, et al. Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (tms) in treatmnt-resistant depression. Depress Anxiety. 2012 Jun 11. doi:10.1002/da.21967. [Epub ahead of print]

Kreuzer PM, Landgrebe M, Frank E, Langguth B. Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus After Traumatic Brain Injury: A Case Study. J Head Trauma Rehabil. 2012 Jun 8. [Epub ahead of print]

Schulz R, Gerloff C, Hummel FC. Non-invasive brain stimulation in neurological diseases. Neuropharmacology. 2012 Jun 8. [Epub ahead of print]

Fitzgerald PB, Grace N, Hoy KE, Bailey M, Daskalakis ZJ. An open label trial of clustered maintenance rTMS for patients with refractory depression. Brain Stimul. 2012 Jun 1. [Epub ahead of print]

Lee JC, Blumberger DM, Fitzgerald P, Daskalakis Z, Levinson A. The Role of Transcranial Magnetic Stimulation in Treatment-Resistant Depression: A Review. Curr Pharm Des. 2012 Jun 6. [Epub ahead of print]