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Updated August 2026 · Reviewed by Nefretiri Abat, PMHNP-BC
Most insurance plans approve TMS as a complete acute course of 36 sessions, delivered 5 days a week for about 6 weeks and finished with a 6-session taper over 3 weeks. The authorization covers the block, not one visit at a time, which is why the prior-authorization stage matters more than any individual claim. This article explains how session counts, extensions, and second courses actually get decided.
The 36-session structure comes from the clinical trial protocols behind FDA clearance and is written into Medicare local coverage policy and most commercial plan criteria. Plans authorize the full course once, under CPT codes 90867 (initial mapping and first treatment), 90868 (subsequent treatments), and 90869 (re-mapping when needed).
If your clinician believes more sessions are warranted, the request is reviewed separately, and the deciding evidence is measured change. A chart that shows PHQ-9 scores falling across the course argues for itself; a chart that says “patient improving” does not. This is one reason we score symptoms at regular intervals during treatment at our Hayward TMS program.
Depression can return after a successful course. Most plans cover re-treatment when you responded the first time, symptoms have measurably returned, and a minimum interval has passed. Our guide to TMS maintenance and re-treatment coverage covers this in depth.
Session-extension denials are appealable like any other, and California adds independent medical review through the DMHC when internal appeals fail. See what to do when insurance denies TMS.
If a full course finishes without adequate response, there are further evidence-based options. See what happens if neither Spravato nor TMS works.
Most plans authorize a full acute course of 36 sessions: 5 sessions per week for about 6 weeks, followed by a 6-session taper over 3 weeks. Insurers approve the course as a block once medical necessity criteria are met.
Requests beyond the standard course get a separate medical-necessity review. Insurers generally look for documented response to the first course, measured with a rating scale such as the PHQ-9, before authorizing additional sessions or re-treatment.
Often yes, if you responded to the first course and symptoms have returned after an interval. Re-treatment is reviewed on its own documentation, so measured symptom scores from the first course matter.
No. The plan authorizes up to that number; your clinician adjusts based on response. Stopping early for a good reason does not penalize future coverage, but consistent attendance is what produces results.
This article is educational and is not personal medical or billing advice. Coverage rules vary by plan and change over time. If you are in crisis, call or text 988.
