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Updates to Magellan Care Guidelines for transcranial magnetic stimulation treatment

December 30, 2019

Retroactively effective from July 1, 2019, through June 30, 2020, Magellan Healthcare, Inc. (Magellan) is utilizing updated care guidelines to determine the medical necessity for transcranial magnetic stimulation (TMS).

Independence has contracted with Magellan to perform utilization management activities for behavioral/mental health for members enrolled in an Independence health plan that offers behavioral health services offered through Magellan.*

*Self-funded groups have the option to select a behavioral health vendor other than Magellan. 

Summary of the changes

Below is a summary of the updates to the medical necessity criteria for transcranial magnetic stimulation treatment in the 2019 – 2020 Magellan Care Guidelines:

  • Clinical evaluation clarification. Clinical evaluation determines the patient to have a diagnosis of a severe single or recurrent episode of major depressive disorder confirmed by Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria.
  • Medication treatment resistance. A definition of “good response” was expanded to read: “The patient has a history of good response to TMS during an earlier episode of the treatment-resistant major depressive disorder as evidenced by a greater than 50 percent improvement in a standard rating scale for depressive symptoms (e.g., PHQ-9, BDI, MADRS, GDS, QIDS, HAM-D, IDS-SR).”
  • Transcranial magnetic stimulation retreatment. The TMS retreatment guideline was expanded to allow adequate time between treatments for clinical assessment and for assessment via one of the depressive symptoms rating scales to clearly document that the patient responded and then relapsed, typically 90 days after their most recent TMS session.
  • Intensity and quality of service. The requirement that the physician be credentialed by Magellan to perform TMS was removed: “Requesting provider may not be credentialed for accounts that don’t utilize Magellan’s provider network.”

To review the updates in more detail, please access the 2019 – 2020 Magellan Care Guidelines. Providers may also access a summary of revisions to the guidelines.

Updated policy

Medical Policy #07.03.22d: Transcranial Magnetic Stimulation (TMS) was updated and posted as a Notification on December 17, 2019, and it will be effective March 16, 2020.

However, the Magellan Care Guidelines are retroactively effective from July 1, 2019.

To view the Notification for this policy, please visit our Medical Policy Portal.

Learn more

For more information on other available tools and resources, please visit the Magellan website or go to the NaviNet® web portal (NaviNet Open) and select Health and Wellness under Administrative Tools & Resources.

Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence members.

NaviNet® is a registered trademark of NantHealth, an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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