In most cases, yes. Original Medicare in New York, New York State Medicaid and the large commercial insurers all publish policies that cover TMS for adults with major depression that has not improved with antidepressants. Coverage is conditional, though: you have to meet each plan's written criteria, and most plans pay only for a standard course of TMS for depression, not for maintenance sessions, most accelerated protocols or other conditions.
This guide summarizes what New York payers say, quoting each policy by number and date. Payer criteria change, sometimes several times a year. Treat everything below as a starting point and confirm the current criteria with your own plan before you start treatment.
The short answer, plan by plan
The table shows the policy each payer uses and the version this guide quotes. All of these documents were read on October 7, 2026.
| Plan type | Policy and version quoted | Covers TMS for depression? | Headline requirements |
|---|---|---|---|
| Original Medicare (New York) | LCD L33398, version 40, revision effective August 9, 2026 | Yes, adults | One medication trial using agents from at least two classes (or another route), plus a psychotherapy trial |
| NYS Medicaid and Medicaid managed care | NYS Medicaid Update Volume 41, Number 7 (July 2025; new text highlighted September 30, 2026); effective October 1, 2025 (fee-for-service) and November 1, 2025 (managed care) | Yes, age 18 and older | Two therapeutic-dose trials of two different antidepressants |
| Aetna | Clinical Policy Bulletin 0469, last reviewed July 17, 2026 | Yes, age 15 and older | Adults: two antidepressants from two classes plus an augmentation trial |
| Cigna / Evernorth | Coverage Policy EN0383, effective March 15, 2026 | Yes, age 15 and older | Adults: two or more failed trials from two classes, plus psychotherapy |
| UnitedHealthcare / Optum | Optum BH803TMS112025, annual review November 18, 2025, interim review April 21, 2026 | Yes, age 15 and older since January 1, 2026 | Adults: two medication regimen trials from two classes; no psychotherapy requirement |
| Anthem (formerly Empire BlueCross BlueShield) | MCG guideline B-801-T, 28th edition, effective September 1, 2024 | Reviewed case by case under MCG | Criteria text is not posted publicly; ask Anthem for it in writing |
| TRICARE | TRICARE "Is It Covered?" page, updated October 1, 2026 | Yes, adults, outpatient | Detailed criteria not published on that page |
Before you rely on this table, call your plan and confirm its current TMS criteria. A policy can be revised the month after this page was written, and your employer's plan documents can add or remove benefits.
What almost every insurer asks for
The wording varies, but the same building blocks appear in nearly every New York policy. If you can document these, you are most of the way to an approval.
- A confirmed diagnosis of major depressive disorder. Medicare's billing article, Optum and NYS Medicaid list two diagnosis codes: F32.2 and F33.2, which describe a severe single or recurrent episode without psychotic features. Aetna asks for a psychiatrist-confirmed diagnosis of severe depression documented on a standardized scale.
- Antidepressants that did not work or could not be tolerated. Most commercial plans and Medicaid want two trials; Medicare's wording is different. The details are in our guide to how many antidepressants you need to try before TMS is covered.
- Sometimes, a trial of psychotherapy. Medicare and Cigna require an adequate trial of evidence-based psychotherapy that did not bring significant improvement. Optum removed its psychotherapy requirement in 2023, and Aetna does not require one for adults.
- A baseline score on a validated depression scale, such as the PHQ-9, Beck Depression Inventory, HAM-D or MADRS, repeated during or after the course. Our article on tracking progress with the PHQ-9 and other scales explains what these are.
- An FDA-cleared device used according to its labeling.
- A qualified prescriber. Medicare requires direct supervision by a physician (MD or DO). Aetna and Optum also accept a psychiatric-mental health nurse practitioner, and Optum lists New York among the states where those nurse practitioners qualify.
- No exclusions. Common ones are active suicidality, psychotic symptoms, a seizure disorder and metal or implanted devices near the head.
Those exclusions are there for safety, not to deny care. Someone in acute danger needs faster help than a six-week course can give. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
Medicare in New York
New York Medicare claims fall under one regional policy, LCD L33398, run by the contractor now called Wellpoint Federal (formerly National Government Services). Medicare policies in other states differ, so advice written for Florida or California Medicare does not apply here.
Under L33398 (revision effective August 9, 2026), an adult with confirmed major depression qualifies through one of four routes: no meaningful response to a medication trial using agents from at least two classes; intolerance of two trials from two classes with distinct side effects; a good response to TMS in an earlier episode; or currently receiving ECT. In every case, a psychotherapy trial without significant improvement is also required. The policy sets no fixed session count, though sessions beyond "established parameters" can be reviewed.
If you have Original Medicare, Part B generally pays after your deductible ($283 in 2026), and you usually owe 20% of the Medicare-approved amount when the provider accepts assignment. Medicare Advantage plans must follow the same local coverage rules and can add their own criteria only where Medicare's are not fully established. Our physician-written page on Medicare coverage for TMS in New York goes line by line through L33398.
Medicaid, Child Health Plus and the Essential Plan
New York Medicaid began covering TMS for treatment-resistant depression on October 1, 2025 for fee-for-service members and November 1, 2025 for Medicaid managed care plans. Its definition of treatment resistance is two trials of two different antidepressants at a therapeutic dose for a sufficient duration, with no class rule and no psychotherapy requirement stated. The state's notice says plainly that TMS is not first-line therapy and is not indicated for acute suicidality or psychotic depression, and that OCD is not currently a reimbursed indication.
Managed care plans add their own process. MetroPlusHealth requires prior authorization and, under its policy BMD-110 (effective November 1, 2025), treats TMS as experimental for members under 18. Fidelis Care lists TMS as covered with authorization required on its Medicaid, Essential Plan and Ambetter grids (notice effective October 1, 2024). Optum's New York criteria extend the Medicaid rules to Child Health Plus and, from November 1, 2026, to the Essential Plan. For more detail, see Does New York Medicaid cover TMS?
Commercial plans: where they differ
Aetna, Cigna and Optum agree on the broad outline but differ in ways that matter to individual patients.
Age
All three now cover TMS for depression from age 15. Medicaid and MetroPlusHealth start at 18. Families can read more in TMS for teens and young adults.
Number of sessions
Aetna and Optum allow up to 30 daily sessions plus 6 tapering sessions; Cigna describes an initial course as 30 to 36 treatments.
OCD
Cigna's EN0383 covers deep TMS for adults with OCD who meet its criteria. Aetna and Optum list OCD as experimental or unproven, and Medicare's LCD says deep TMS is not reasonable and necessary for OCD. If OCD is your main concern, read TMS for OCD before you call your plan.
Prior authorization
Evernorth (Cigna's behavioral health arm) stopped requiring prior authorization for TMS on March 6, 2026, but only for its contracted providers; out-of-network providers must still obtain it. Other plans, including MetroPlusHealth and Fidelis Care, still require approval before the first session, so ask yours. The process is laid out in TMS prior authorization, step by step.
What insurance usually does not cover
Even a plan that covers TMS will usually exclude some versions of it. These are the most common gaps.
- Maintenance or booster sessions. Medicare, Aetna, Cigna and Optum all exclude scheduled maintenance TMS. A new course after a relapse is a separate question; see TMS maintenance and booster sessions.
- Accelerated protocols, including SAINT. Aetna, Cigna and Optum list accelerated TMS as experimental or unproven, and MetroPlusHealth says the evidence is insufficient. More in Is accelerated TMS covered by insurance?
- Theta-burst (iTBS), depending on the plan. Aetna's policy covers iTBS delivered on an FDA-cleared device, while Cigna and Optum list theta-burst protocols as experimental or unproven.
- Conditions other than major depression. PTSD, bipolar disorder and smoking cessation appear on both Aetna's and Optum's experimental or unproven lists (Aetna's also names anxiety disorders), and EmblemHealth marks TMS for non-depression indications as not covered.
- Repeat courses too soon. Aetna will not cover a repeat course within 60 days of the last one; Optum and MetroPlusHealth look for relapse 6 months after the most recent treatment.
- TMS during pregnancy or breastfeeding, under Optum. Optum lists it as unproven.
New York protections worth knowing
New York law gives you more leverage than many patients realize. Group plans may not apply financial requirements or treatment limits to mental health benefits that are more restrictive than those applied to most medical and surgical benefits. Insurers must also give you their mental health medical-necessity criteria if you ask.
For state-regulated plans, a preauthorization decision is due within three business days of receiving the necessary information. Since July 1, 2025, New York's behavioral health access rules require an initial appointment within 10 business days; if the network cannot meet that, the plan must allow out-of-network care at in-network cost-sharing. Whether that rule reaches a full TMS course is not spelled out, so ask your plan in writing. If a claim is denied as not medically necessary or experimental, you can request an internal appeal and then a state external appeal. Our guide to appealing a TMS denial in New York walks through each step.
How to check your own coverage
- Find out who manages your mental health benefits. The back of your card may list a separate behavioral health company, such as Optum, Evernorth or Carelon, and that company holds the TMS policy.
- Call and ask about the TMS billing codes. The standard codes are 90867 (the first session, including mapping), 90868 (each later session) and 90869 (a session with motor threshold re-measured). Ask whether each is covered, whether prior authorization is needed, and what your deductible, copay or coinsurance will be.
- Ask for the written criteria and the policy number. Write down the policy name, its effective date and the representative's name and reference number for the call.
- Collect your treatment history. A list of every antidepressant, the dose, the dates and why it stopped will save weeks later.
- Ask whether the TMS clinic is in your plan's network. Out-of-network benefits work differently; see out-of-network TMS and superbills. If you have no coverage at all, what TMS costs without insurance explains self-pay pricing.
A TMS team will usually run a formal benefits check for you once you have had a consultation. You can read more on our TMS service page, or browse the full TMS patient guide. Whichever route you take, confirm the current criteria directly with your plan, because the policies quoted here will be revised.
Sources
- LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal (formerly National Government Services), CMS Medicare Coverage Database, 2026. cms.gov
- New York State Medicaid Coverage of Therapeutic Transcranial Magnetic Stimulation (NYS Medicaid Update, Vol. 41 No. 7). New York State Department of Health, 2025. healthweb-back.health.ny.gov
- Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
- Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com
- Behavioral Clinical Policy: Transcranial Magnetic Stimulation (BH803TMS112025). Optum Behavioral Health Solutions, 2026. providerexpress.com
- Transcranial Magnetic Stimulation for Treating Physical Health Conditions (2026T0536W). UnitedHealthcare, 2026. uhcprovider.com
- Frequently asked questions: Our upcoming rebrand to Anthem (Provider Bulletin). Empire BlueCross BlueShield / Anthem, 2023. providers.anthem.com
- MCG Care Guidelines 28th edition (Anthem New York provider news). Anthem Blue Cross and Blue Shield (New York), 2024. providernews.anthem.com
- Is It Covered? Transcranial Magnetic Stimulation. TRICARE (Defense Health Agency), 2026. tricare.mil
- Billing and Coding: Transcranial Magnetic Stimulation (A57528, version 5). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
- Fidelis Care Authorization Grids Effective October 1, 2024 (provider notice). Fidelis Care, 2024. fideliscare.org
- Transcranial Magnetic Stimulation: Full Practice Authority Nurse Practitioner States. Optum Behavioral Health Solutions, 2026. providerexpress.com
- NGS to begin operating under new name. American Podiatric Medical Association, 2026. apma.org
- Local Coverage Final LCDs report (all MACs). CMS Coverage API, 2026. api.coverage.cms.gov
- Medicare costs. Medicare.gov (CMS), 2026. medicare.gov
- 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) fact sheet. Centers for Medicare & Medicaid Services, 2023. cms.gov
- Medicaid Update - New York State Medicaid Coverage of Therapeutic Transcranial Magnetic Stimulation (provider notice). MetroPlusHealth, 2025. metroplus.org
- Repetitive Transcranial Magnetic Stimulation (TMS) Policy and Procedure (BMD-110). MetroPlusHealth, 2025. metroplus.org
- New York Medicaid and Essential Plan: Transcranial Magnetic Stimulation (BH803NYTMS122025). Optum Behavioral Health Solutions, 2026. providerexpress.com
- TMS prior authorization requirement removal: FAQ for contracted providers (PCOMM-2026-021). Evernorth Behavioral Health, 2026. campaigns.cigna.com
- EmblemHealth Medical Technology Database. EmblemHealth, 2025. emblemhealth.com
- New York Insurance Law Section 3221 (group mental health coverage). New York State Senate, 2026. nysenate.gov
- New York Insurance Law Section 4903 (Utilization review determinations). New York State Senate, 2026. nysenate.gov
- DFS press release: network adequacy and access standards for behavioral health. New York State Department of Financial Services, 2025. dfs.ny.gov
- File an External Appeal. New York State Department of Financial Services, n.d.. dfs.ny.gov
FAQs
Does Medicare cover TMS in New York?
Yes, for adults with major depression who meet LCD L33398 (revision effective August 9, 2026), including a failed medication trial and a psychotherapy trial. Part B coinsurance and the deductible apply. Confirm current criteria with Medicare or your Medicare Advantage plan.
Will my insurance pay for TMS if I have only tried one antidepressant?
Usually not under commercial plans or Medicaid, which generally want two trials. Medicare's wording centers on one trial using agents from at least two classes, plus psychotherapy. Your plan's current policy is the deciding document.
Is TMS for anxiety or PTSD covered?
Generally not on its own. Aetna lists anxiety disorders and PTSD as experimental, and Optum lists PTSD as unproven. Some devices are cleared for anxiety symptoms that occur alongside major depression; in that case coverage still turns on your plan's depression criteria.
How long does insurance approval take?
For state-regulated New York plans, the insurer must decide within three business days of receiving all necessary information. Medicare Advantage and Medicaid plans have a federal standard of seven calendar days. Missing paperwork is the most common cause of delay.
Does insurance cover a second course of TMS?
Often, if the first course worked and you later relapsed. Plans set conditions such as at least 50% improvement from the earlier course and a minimum gap between courses. Scheduled maintenance sessions are usually excluded.
