- 21297 Foothill Blvd, Ste 203 Hayward, CA 94541 (by appointment only)
- (415) 636-9700
- hello@exxceedwellness.com
Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
TMS prior authorization is won or lost in the documentation. Reviewers do not meet you; they read a packet. This checklist covers exactly what that packet must contain, based on the criteria Medicare and major commercial plans apply, so you can gather the pieces before your first visit and avoid the most common delays.
A complete TMS prior-authorization packet documents: a confirmed diagnosis of major depressive disorder; a baseline severity score, most often the PHQ-9; every antidepressant trial with drug name, dose reached, weeks taken, and what happened; psychotherapy history where the plan requires it; and safety screening covering ferromagnetic implants near the head, cochlear implants, and personal seizure history.
Reviewers apply a specific definition of a failed trial: appropriate drug, therapeutic dose, adequate duration, insufficient response. Many patients have taken five antidepressants but can document only two adequate trials, and the review counts what is documented. Our article on what makes an antidepressant trial adequate explains the definitions plans use.
Request pharmacy dispensing histories, gather prior psychiatric records, and write out your own medication timeline from memory as a starting map. At our Hayward clinic, we build and submit the packet, and we verify benefits first, but patients who arrive with their history in hand cut the timeline substantially. See also verifying insurance before treatment and how long approval takes.
A major depressive disorder diagnosis, a baseline symptom score such as the PHQ-9, a complete antidepressant trial history with drug names, doses, durations, and outcomes, psychotherapy history, and screening for contraindications such as ferromagnetic implants near the head or seizure history.
A medication from an appropriate class taken at a therapeutic dose for an adequate duration, usually 4 to 8 weeks, without sufficient improvement. A trial stopped early for intolerable side effects can also count if documented.
It helps significantly. Pharmacy printouts, prior clinician notes, and even a personal written medication timeline speed up the review. Your TMS clinic assembles the packet, but gaps in history are the most common reason reviews stall.
Once a complete packet is submitted, most plans decide within days to about two weeks. Incomplete documentation is what turns a two-week process into a two-month one.
This article is educational and is not personal medical or billing advice. Plan criteria vary and change over time. If you are in crisis, call or text 988.
