What TMS costs in New York and how insurers approve it

Every major insurer operating in New York covers TMS for major depressive disorder, but all of them require documented failure of prior treatment first. Empire BlueCross BlueShield and EmblemHealth downstate, Excellus BlueCross BlueShield across upstate, Highmark Blue Cross Blue Shield of Western New York, Independent Health, MVP Health Care, Healthfirst, Fidelis Care, Aetna, Cigna and UnitedHealthcare/Oxford typically require trials of two to four antidepressants from more than one class, usually alongside a course of psychotherapy. Medicare covers TMS in New York under the local coverage determination administered by National Government Services, the Medicare contractor for Jurisdiction K, which requires trials of four medications or documented intolerance. Coverage under New York Medicaid and its managed care plans is more limited than commercial coverage and prior authorization is strict — confirm with the clinic before you start. Most New York clinics handle the authorization paperwork for you — ask before your consultation.