Get Anthem Tms Prior Auth Form

What is the Criteria for TMS Therapy? To qualify for coverage, patients must have been diagnosed with MDD and already tried psychotherapy and at least four antidepressants from two different drug classes (SSRIs, SNRIs, MAOIs, or atypical agents) without seeing results.

The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

TMS has approval from the U.S. Food and Drug Administration (FDA) to treat four conditions: Major depressive disorder (MDD) (including treatment-resistant depression). Obsessive-compulsive disorder (OCD). Migraines.

Treatment was provided at the following requirements: TMS = MT 120%, 10 rep, 10Hz, trains of four seconds duration, 26 seconds intertrain interval (40 pulses per train) for a total of 75 pulse trains (300 pulses) over the Dorsolateral Prefrontal Cortex (DLPFC) for at least four weeks.

It has been FDA-cleared to treat Major Depressive Disorder (MDD) since 2013, Obsessive-Compulsive Disorder (OCD) since 2018, smoking cessation since 2020, and anxious depression since 2021.

The behavioral health plans may require prior authorization for TMS even though medical plans typically do not. Forgetting the prior authorization likely means a TMS claim will be denied. Services provided on an emergency basis should be documented and can be used to support retro-authorization requests.

NHS Availability of TMS Treatment Where the NHS do offer TMS treatment, the Trusts also have strict criteria that patients are required to meet before receiving treatment. This usually includes: Multiple unsuccessful courses of antidepressants and even ECT. Patients must be living within the catchment area for the ...

What is the Criteria for TMS Therapy? To qualify for coverage, patients must have been diagnosed with MDD and already tried psychotherapy and at least four antidepressants from two different drug classes (SSRIs, SNRIs, MAOIs, or atypical agents) without seeing results.