Does Aetna cover TMS therapy?

Yes — when medical necessity criteria are met: FDA-cleared device, age 15+, confirmed diagnosis of severe MDD without psychosis, inadequate response to antidepressants and augmentation, and psychiatrist/PMHNP supervision.

How many TMS sessions does Aetna allow?

Typically 30 sessions over 6 weeks plus 6 tapering sessions (36 total). Additional sessions may be reviewed for medical necessity.

Can I get retreatment if symptoms return?

Retreatment may be covered if initial criteria were met, prior response was ≥50% and maintained for at least two months, and relapse occurred despite appropriate care.

Aetna TMS Coverage | Coral Springs | InsuranceClaimGuideFL

Aetna Coverage for TMS Therapy in Coral Springs

Understand Aetna’s medical-necessity rules for FDA-cleared Transcranial Magnetic Stimulation (TMS)—and how to get approved quickly.

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Medical Necessity Criteria

Eligibility Checklist

FDA-cleared TMS device (including iTBS) used per labeled protocols
Age 15 or older
Psychiatrist-diagnosed severe major depressive disorder (no psychosis) documented with validated rating scales (BDI, HDRS, MADRS)
No contraindications to TMS (see below)
Failed adequate trials of two antidepressants from different classes, plus augmentation (each ≥8 weeks at therapeutic dose)

Treatment Parameters & Oversight

Standard course: 30 sessions (5×/week × 6 weeks) + 6 taper sessions over 3 weeks
Additional sessions (beyond 36) may be reviewed for medical necessity
Use an FDA-approved/cleared device per manufacturer protocol or evidence-supported variations
Order by a psychiatrist (MD/DO) or PMHNP who supervises mapping, dosing, and progress
TMS operator is clinically trained, remains in the room, and monitors safety

We handle Aetna documentation, prior authorization, and rating-scale reporting for you.

Exclusions & Investigational Criteria

Contraindications

Recent substance abuse or active suicidality
Metal implants or fragments near the head, cochlear implants, stents, or clips
Neurological conditions (e.g., stroke, tumors, dementia, elevated intracranial pressure)
Implanted devices (pacemaker, DBS, VNS, spinal cord stimulator)
Severe cardiovascular disease without clearance
Tattoos with ferromagnetic ink on head/neck

Investigational / Not Covered

Accelerated or MRI-guided TMS (e.g., SAINT)
TMS combined with ketamine or EEG
Magnetic e-Resonance Therapy (MeRT)
Maintenance TMS beyond 36 sessions
TMS for conditions without established effectiveness (e.g., Alzheimer’s, bipolar, migraines, substance addiction, Tourette’s, stroke rehab)

Note on CES: Cranial Electrical Stimulation devices (e.g., Fisher Wallace) are considered not medically necessary for psychiatric/neurologic indications.

Retreatment Policy

Met all initiation criteria in prior course
Achieved ≥50% symptom reduction maintained ≥2 months
Relapse occurred despite psychotherapy/pharmacotherapy
One re-mapping included; additional as needed if threshold changes occur

New to TMS? See How It Works and Conditions We Treat.