Usually not. As of October 2026, the major commercial policies that apply in New York call accelerated TMS experimental or unproven: Aetna names accelerated and MRI-guided TMS including SAINT, Cigna names SAINT and other accelerated protocols, and Optum (which handles UnitedHealthcare behavioral health) lists accelerated protocols as unproven. Medicare's New York policy does not mention accelerated TMS at all. A standard once-a-day course is far more likely to be covered.
FDA clearance and insurance coverage are separate decisions. Some accelerated schedules are now FDA-cleared, including SAINT and newer protocols from other manufacturers, while others, such as single-day regimens combined with medication, are not cleared and are used off-label. Every policy below was checked on October 7, 2026. Payer criteria change, so confirm the current version with your plan.
What insurers mean by "accelerated"
Accelerated TMS packs several sessions into each treatment day so the course finishes in days or a couple of weeks instead of about six weeks. SAINT, for example, condenses treatment to five days: 50 sessions and 90,000 pulses, compared with 30 sessions over 6 weeks for the standard once-daily theta-burst protocol it was compared with. Insurers lump these schedules together, whatever the device, coil or targeting method.
It helps to separate three things a policy may treat differently:
- Standard rTMS: one session a day, five days a week. This is what most policies cover.
- Theta-burst (iTBS) once a day: a shorter pulse pattern on the usual daily schedule. Some plans cover it; some do not.
- Accelerated protocols: several sessions a day, with or without MRI-guided targeting. Rarely covered.
The physician's guides to accelerated TMS protocols and their FDA status and what SAINT is and is not explain the science.
Payer by payer
| Plan and policy (date checked) | Once-daily iTBS | Accelerated / SAINT |
|---|---|---|
| Aetna, CPB 0469 (last review July 17, 2026) | Covered on an FDA-cleared device if criteria are met | Experimental; SAINT codes 0889T to 0892T not covered |
| Cigna/Evernorth, EN0383 (effective March 15, 2026) | Theta-burst listed among experimental accelerated protocols | Experimental, investigational or unproven |
| UnitedHealthcare/Optum, BH803TMS112025 (interim review April 21, 2026) | Theta-burst protocols unproven | Unproven |
| MetroPlusHealth, BMD-110 (effective November 1, 2025) | Insufficient evidence | Insufficient evidence |
| Medicare in New York, LCD L33398 v40 (revision effective August 9, 2026) | Not named | Not named |
| NYS Medicaid (Medicaid Update, July 2025) | Not addressed | Not addressed |
| Anthem (formerly Empire BCBS), MCG B-801-T, 28th edition (effective September 1, 2024) | Not publicly verifiable | Not publicly verifiable |
Two details matter. Aetna is the outlier on once-daily theta burst: its policy explicitly includes iTBS on an FDA-cleared device, so a five-day-a-week iTBS course may be covered when an accelerated schedule is not. And Anthem reviews TMS with a proprietary guideline that is not published, so ask Anthem for its accelerated TMS criteria in writing. Full policies: Aetna CPB 0469, Cigna EN0383 and Optum's behavioral policy.
Medicare: silent, not a yes
New York's Medicare policy covers rTMS for adults with major depression who meet its criteria, and it says treatment should generally follow the protocol in the device manufacturer's user manual. It sets no fixed session count and does not mention theta burst, iTBS or accelerated TMS by name. Because some accelerated schedules are now part of cleared device labeling, how Medicare handles a claim for several sessions in one day is not settled by the policy text. Its billing article warns that services "in excess of established parameters may be subject to review for medical necessity."
CMS has published 2026 hospital outpatient payment rates for the SAINT codes: $3,750.50 per treatment day for 0890T to 0892T and $950.50 for target development (0889T), against $220.60 for a standard TMS session code in the same setting. These are hospital outpatient rates, not office rates, and a payment rate does not guarantee that a particular claim will be paid. Medicare Advantage plans must follow the same local policy. If you have Medicare, ask the TMS team in advance how they would bill a multi-session day and whether they expect Medicare to review it.
Why insurers are holding back
Insurers want large, independent, sham-controlled trials, and the accelerated evidence is promising but uneven. SAINT's widely quoted remission figure comes from an open-label study of 21 to 22 people; its only sham-controlled data are 29 people from a single-site trial stopped early, and FDA noted uncertainty about the blinding. FDA's own summary says effectiveness "has not been established beyond the timepoints evaluated" in its studies, which ran four weeks after treatment.
The wider evidence is growing. A 2026 meta-analysis pooled 15 sham-controlled trials of accelerated iTBS (704 participants) and found roughly double the response rate with active treatment, though only 46% of the trials were at low risk of bias. A 2025 Brazilian trial of 100 people reported response in 52% with active accelerated iTBS versus 22% with sham. Policies are reviewed on a yearly cycle, so they tend to lag new studies; Aetna's next scheduled review is May 13, 2027.
What it means for cost
If your plan excludes accelerated TMS, you would normally pay the full fee yourself, and the codes used for SAINT-type treatment are among those Aetna and Cigna will not cover. Neutral price data are scarce. One clinic's published estimates, which come from a commercial source with no stated method, list accelerated iTBS courses at $7,000 to $14,000 and SAINT at $30,000 to $36,000. Treat those as rough signals, not quotes; ask any clinic for a written, itemized estimate.
The trade-off is time versus money. A covered standard course often runs five days a week for four to six weeks, about 30 to 36 sessions, which means many trips. An accelerated course is shorter but may be entirely out of pocket. Some people choose a covered daily course and plan their schedule around it; see a typical course week by week and what TMS costs without insurance.
Billing has its own wrinkle. Even plans that cover daily TMS may cap billable units per day: Evernorth's FAQ, for example, allows up to two units of 90868 per day under Medically Unlikely Edit limits. Ask how extra same-day sessions would be billed before you agree to a schedule.
Can you appeal an "experimental" denial?
Yes. In New York, an external appeal is available when a plan denies care as experimental or investigational. Your physician completes an attestation form stating that standard treatments "have been ineffective or would be medically inappropriate," or that no more beneficial standard treatment is covered by the plan. A realistic appeal explains why a standard daily course is not suitable for you specifically, for example because you already had a full course without benefit, rather than arguing that accelerated TMS is better in general. The steps are in appealing a TMS denial in New York.
Questions to ask before you book
- Ask your plan for its TMS policy number and revision date, and whether it covers once-daily iTBS, accelerated TMS, or neither.
- Ask whether prior authorization is required and whether the request should name the protocol. The guide to TMS prior authorization covers the paperwork.
- Ask the TMS team which protocol they propose, whether it is FDA-cleared as scheduled, and which CPT codes they would bill.
- If only part of the course would be covered, ask who pays for the rest and get it in writing.
- Ask what happens if you do not respond: is a standard course offered afterward, and would your plan cover it?
For the bigger picture, read whether insurance covers TMS, browse the TMS guide, or see the TMS therapy page.
Sources
- 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
- Repetitive Transcranial Magnetic Stimulation (TMS) - Policy and Procedure (BMD-110). MetroPlusHealth, 2025. metroplus.org
- LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
- Billing and Coding: Transcranial Magnetic Stimulation (A57528, version 5). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
- New York State Medicaid Coverage of Therapeutic Transcranial Magnetic Stimulation (Medicaid Update Vol. 41 No. 7). New York State Department of Health, 2025. healthweb-back.health.ny.gov
- MCG Care Guidelines 28th edition (Anthem NY provider news). Anthem Blue Cross and Blue Shield (New York), 2024. providernews.anthem.com
- 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) fact sheet. Centers for Medicare & Medicaid Services, 2023. cms.gov
- Addendum B. OPPS Payment by HCPCS Code for CY 2026 (October 2026). Centers for Medicare & Medicaid Services, 2026. cms.gov
- 510(k) Premarket Notification K220177 and 510(k) Summary (Magnus Neuromodulation System with SAINT Technology). U.S. Food and Drug Administration, 2022. accessdata.fda.gov
- 510(k) Premarket Notification K260189 (MagVenture Accelerated TMS Therapy System). U.S. Food and Drug Administration, 2026. accessdata.fda.gov
- 510(k) Premarket Notification K251449 (BrainsWay accelerated Deep TMS). U.S. Food and Drug Administration, 2025. accessdata.fda.gov
- Clinical TMS Society's Statement on Level of Evidence for Single-Day TMS combined with Medications. Clinical TMS Society, 2025. clinicaltmssociety.org
- Accelerated intermittent theta-burst stimulation for major depressive episodes: systematic review and dose-response meta-analysis. Brain Stimulation, 2026. pubmed.ncbi.nlm.nih.gov
- Accelerated Theta-Burst Stimulation for Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry, 2025. pmc.ncbi.nlm.nih.gov
- How Much Does TMS for Depression Cost? (clinic blog; commercial interest). Cognitive FX, 2026. cognitivefxusa.com
- Transcranial Magnetic Stimulation (TMS). Cleveland Clinic, 2026. my.clevelandclinic.org
- TMS prior authorization requirement removal - FAQ for contracted providers (PCOMM-2026-021). Evernorth Behavioral Health, 2026. campaigns.cigna.com
- File an External Appeal. New York State Department of Financial Services, 2026. dfs.ny.gov
FAQs
Does insurance cover SAINT?
Not under the current Aetna, Cigna or Optum policies, which call SAINT or accelerated protocols experimental or unproven. Medicare's New York policy does not mention it. Confirm with your own plan, since policies change.
If accelerated TMS is FDA-cleared, why won't my plan pay?
FDA clearance means a device can be marketed for an indication. Coverage depends on whether the insurer judges the evidence strong enough to call it medically necessary, which is a separate decision.
Is theta-burst stimulation the same as accelerated TMS?
No. Theta burst is a pulse pattern that can be given once a day or several times a day. Aetna covers once-daily iTBS on a cleared device; Cigna and Optum list theta-burst protocols as experimental or unproven.
Can I use HSA or FSA money for accelerated TMS?
HSA and FSA funds can pay for medical care as the tax code defines it, which IRS guidance says includes psychiatric care. TMS is not named, so confirm with your account administrator.
