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Anthem Blue Cross plans in California generally cover TMS therapy for major depressive disorder when medical necessity criteria are met, and prior authorization is nearly always required. The deciding factor is documentation: your plan wants proof that antidepressant treatment was tried at an adequate dose for an adequate duration and did not produce an adequate response. Anthem Blue Cross and Blue Shield of California are separate companies with separate policies, so confirm which one issues your plan before comparing requirements.
On this page: Is TMS covered? · What Anthem generally requires · How prior authorization works · If you are denied · Checking your own plan
In most California commercial and employer plans, yes, for major depressive disorder that has not responded adequately to medication. TMS is FDA-cleared for MDD, so it is not treated as experimental for that indication, and California’s mental health parity law requires plans to cover medically necessary mental health treatment on the same terms as physical health treatment. Coverage still depends on meeting the plan’s written criteria. Self-funded employer plans administered by Anthem can set their own rules, which is why two people with an Anthem card can get different answers.
Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
Criteria vary by plan document, but requests typically need to show a diagnosis of major depressive disorder, current episode severity documented with a standardized scale, and an inadequate response to antidepressant trials, commonly at least two, each at an adequate dose and duration. Many plans also ask about a psychotherapy trial, or documentation of why therapy was not appropriate or available. Our guide to what counts as an adequate antidepressant trial explains the dose and duration standard reviewers apply.
Your clinic submits the request with your medication history, symptom scores, diagnosis, and treatment plan. Complete submissions are usually decided within days to about two weeks, and California law provides for expedited review when a delay would seriously threaten your health. Incomplete submissions bounce back with information requests, which restarts the wait. The step-by-step version is in our guide to TMS prior authorization in California.
Denials are usually documentation findings rather than final judgments. You file an internal appeal, and if that fails, most Californians can request a free Independent Medical Review through the state, decided by outside physicians and binding on the plan. Our guide to appealing a TMS denial in California covers both steps.
Call the member services number on your card and ask whether transcranial magnetic stimulation is a covered benefit, whether prior authorization is required, and whether your plan is fully insured or self-funded. A clinic that runs TMS routinely will verify benefits for you and tell you what your plan requires before you commit. Exxceed Wellness is in network with Anthem Blue Cross and several other major plans, and we verify coverage and handle the authorization as part of starting treatment. See also how candidacy is assessed.
This article is educational and is not legal or personalized medical advice. Coverage criteria vary by plan and change over time. Verify benefits with your insurer. Reviewed by Nefretiri Abat, PMHNP-BC, JD.
Anthem authorizes TMS as a course rather than visit by visit. A standard acute course is about 36 sessions, five days a week for roughly six weeks with a taper at the end. Requests beyond that course, and any later course, go through their own medical-necessity review, where documented response to the first course is the deciding evidence. Anthem has also issued policy updates specific to the TMS billing codes 90867, 90868, and 90869, so coding accuracy matters on these claims.
Because re-treatment turns on measured change, we track symptom scores across treatment rather than only at intake. More detail in how many TMS sessions insurance approves and maintenance and re-treatment coverage.
Our prior-authorization documentation checklist covers exactly what the packet must contain.
Generally yes for major depressive disorder that has not responded adequately to medication, with prior authorization required. TMS is FDA-cleared for MDD, and California’s parity law requires plans to cover medically necessary mental health treatment on the same terms as physical health care.
Typically a diagnosis of major depressive disorder, documented symptom severity using a standardized scale, and an inadequate response to antidepressant trials, commonly at least two at adequate dose and duration. Some plans also ask about a psychotherapy trial.
No. They are separate companies with separate policies and criteria. Check which company issues your plan before comparing coverage requirements.
Most denials are documentation findings that can be corrected. File an internal appeal, and if it is denied, most Californians can request a free Independent Medical Review through the state, which is decided by outside physicians and binding on the plan.
Yes. Anthem requires prior authorization for TMS, submitted through its Behavioral Health Utilization Management team. The specific criteria depend on which Anthem product you carry.
TMS is billed under CPT 90867 (initial mapping and treatment), 90868 (subsequent treatments), and 90869 (re-mapping). Anthem has issued policy updates specific to these codes, so accurate coding matters on these claims.
