Local Coverage Article Response to Comments

Response to Comments: Transcranial Magnetic Stimulation


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Document Note

Posted: 8/6/2020
The Notice period was changed to 8/6/2020 through 9/30/2020 and the Effective date for the LCD was changed to 10/1/2020.

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Article ID
Article Title
Response to Comments: Transcranial Magnetic Stimulation
Article Type
Response to Comments
Original Effective Date
Retirement Date
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Article Text

As an important part of Medicare Local Coverage Determination (LCD) development, National Government Services solicits comments from the provider community and from members of the public who may be affected by or interested in our LCDs. The purpose of the advice and comment process is to gain the expertise and experience of those commenting. We would like to thank those who suggested changes to the draft of the Transcranial Magnetic Stimulation LCD.

Although NGS did not receive any comments regarding the use of Transcranial Magnetic Stimulation (TMS) for Obsessive Compulsive Disorder (OCD), comments were received on practitioners for this service. 

The official notice period for the final LCD begins on 06/11/2020, and the final determination will become effective on 08/01/2020.

Response To Comments


Two comments were received asking NGS to revise the LCD to include nurse practitioners (NPs) as providers who may write the order for TMS treatment and to administer TMS.

No information was provided to support training adequacy of NPs to order or perform and supervise TMS. In addition, no literature was provided describing successful NP provision of TMS. Five of the seven Medicare Administrative Contractors (MACs) require a psychiatrist (or neurologist in one instance) to perform the decision-making and require the same for supervision. One requires the decision-making by a psychiatrist and allows non-psychiatric physicians to supervise. NGS requires physicians knowledgeable in TMS for decision-making and supervision. The requirement will not be changed and will continue to read as follows.

The order for treatment (or retreatment) is written by a physician (MD or DO) who has examined the patient and reviewed the record. The physician must have experience in administering TMS therapy and the treatment must be given under direct supervision of this physician, i.e., he or she must be in the area and be immediately available.

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Updated On Effective Dates Status
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