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Transcranial Magnetic Stimulation Clinical Policy Updates

Date: 05/01/26

Provider Update: CP.BH.201 – Deep Transcranial Magnetic Stimulation for Obsessive‑Compulsive Disorder

Effective February 28, 2026, Ambetter from Arizona Complete Health has revised CP.BH.201 clinical policy to define medical necessity criteria for Deep Transcranial Magnetic Stimulation (dTMS) for the treatment of severe, treatment‑resistant Obsessive‑Compulsive Disorder (OCD) in adult members.

Key policy highlights include:

  • Coverage applies to Deep TMS (dTMS) for adult members aged 18 years and older with a DSM‑diagnosed Obsessive Compulsive Disorder.
  •  Members must demonstrate persistent, severe symptoms despite multiple medication trials, with treatment resistance measured using standardized clinical scales.
  • Initial authorization includes up to 36 treatment sessions, when all clinical and documentation criteria are met.

Providers are encouraged to review CP.BH.201 policy for complete eligibility requirements, contraindications, documentation expectations, and coding guidance. Providers are encouraged to use this form when submitting an authorization request: Transcranial Magnetic Stimulation Request Form.pdf

Reference:

CP.BH.201 Deep Transcranial Magnetic Stimulation for Obsessive‑Compulsive Disorder is available on our Ambetter website > https://www.azcompletehealth.com/ >click on AZ in state map > For Providers 

Questions? Contact your Provider Engagement Account Manager. Need their contact information? Email us at:                                      📧  AzCHProviderEngagement@azcompletehealth.com.

 

Provider Update: CP.BH.200 - Transcranial Magnetic Stimulation for Treatment Resistance Major Depression

Effective February 28, 2026, Ambetter from Arizona Complete Health has implemented a policy revision for CP.BH.200 Transcranial Magnetic Stimulation for Treatment Resistant Major Depression

The CP.BH.200 clinical policy has been updated to clarify and standardize medical necessity criteria for Transcranial Magnetic Stimulation (TMS) for members with treatment resistant Major Depressive Disorder (MDD).

Key policy updates include:

  • ·Clarified documentation requirements for TMS, including an active course of psychopharmacologic and psychotherapeutic treatment with trials of evidence-based antidepressants and structured psychotherapy.
  • Removed electroconvulsive therapy (ECT) failure requirements and clarified eligible provider types to include Psychiatric Mental Health Nurse Practitioners (PMHNPs).
  • Revised contraindication language related to ketamine/esketamine therapy and added guidance that psychotropic medications should generally remain unchanged during TMS treatment unless clinically justified and documented.

Providers are encouraged to review CP.BH.200 policy for complete clinical criteria, documentation requirements, and exclusions. Providers are encouraged to use this form when submitting an authorization request: Transcranial Magnetic Stimulation Request Form.pdf

Reference:

Policy CP.BH.200 Transcranial Magnetic Stimulation for Treatment Resistance Major Depression.  is available on our Ambetter website www.ambetterhealth.com > click on AZ in state map > For Providers

Questions? Contact your Provider Engagement Account Manager. Need their contact information? Email us at:

📧  AzCHProviderEngagement@azcompletehealth.com.