Brainsway Deep TMS Therapy - for Brain Disorder Treatment

Aetna Insurance Now Covers Transcranial Magnetic Stimulation and Cranial Electrical Stimulation

08/06/2016

Aetna insurance has recently expanded its coverage of transcranial magnetic stimulation for the treatment of depression. Millions of new patients now have access to this treatment!

Here is the policy update:  

"Aetna considers repetitive transcranial magnetic stimulation (rTMS) in a healthcare provider’s office medically necessary when the following criteria are met:

  • Administered by an FDA cleared device and utilized in accordance with the FDA labeled indications; and
  • The member is age 18 years or older; and
  • The member has a confirmed diagnosis of severe major depressive disorder (single or recurrent episode), documented by standardized rating scales that reliably measure depressive symptoms (eg, Beck Depression Scale [BDI], Hamilton Depression Rating Scale [HDRS], Montgomery-Asberg Depression Rating Scale [MADRS], etc.); and
  • There is documentation via legible medical records of failure of a trial of a psychotherapy known to be effective in the treatment of major depressive disorder of an adequate frequency and duration, without significant improvement in depressive symptoms, as documented by standardized rating scales that reliably measure depressive symptoms (eg, Beck Depression Scale [BDI], Hamilton Depression Rating Scale [HDRS], Montgomery-Asberg Depression Rating Scale [MADRS], etc.); and
  • The member is currently receiving or is a candidate for electroconvulsive therapy (ECT) and rTMS is considered a less invasive equally effective treatment option (eg, in cases with psychosis, acute suicidal risk, catatonia or life-threatening inanition rTMS should not be utilized); and
  • The member has no contraindications to rTMS (refer to contraindications below); and
  • The member meets one of the following criteria:
    • There is documentation via legible medical records of failure of four trials of psychopharmacologic agents, including two different agent classes, during the current depressive episode; or
    • The member is unable to tolerate a therapeutic dose of medications as evidenced by documentation via legible medical records of four trials of psychopharmacologic agents with distinct side effects; and
  • Treatment consists of a maximum of 30 sessions (five days a week for six weeks). Note: Treatments beyond 30 sessions may be reviewed for medical necessity."

Read the rest of the policy update here.


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