What TMS costs in Texas and how insurers approve it

Every major insurer operating in Texas covers TMS for major depressive disorder, but all of them require documented failure of prior treatment first. Blue Cross and Blue Shield of Texas, the largest commercial carrier in the state, generally expects trials of multiple antidepressants from more than one class plus a course of psychotherapy. Aetna, Cigna, UnitedHealthcare and Humana typically require two to four failed medication trials. Medicare covers TMS in Texas under the local coverage determination administered by Novitas Solutions, the Medicare contractor for Jurisdiction H, which requires trials of four medications or documented intolerance. Coverage under Texas Medicaid and the STAR managed care plans is far more limited than commercial coverage and prior authorization is strict — confirm with the clinic before you start. Most Texas clinics handle the authorization paperwork for you — ask before your consultation.