FUTURE LCD Reference Article Response To Comments Article

Response to Comments: Transcranial Magnetic Stimulation

A60452

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Source Article ID
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Article ID
A60452
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Transcranial Magnetic Stimulation
Article Type
Response to Comments
Original Effective Date
08/09/2026
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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 Transcranial Magnetic Stimulation LCD. The official notice period for the final LCD begins on June 25, 2026, and the final determination will become effective on August 9, 2026.

Response To Comments

Number Comment Response
1

Commenter stated that "the Medicare program covers services provided by NPs if the service would be covered when provided by a physician, the NP is authorized to perform the service under state law and no other Medicare exclusions apply. LCD 33398 as adopted by NGS Medicare, incorporated this Medicare coverage criteria, and we strongly urge NGS to not amend the supervision requirement, which would be inconsistent with 42 CFR § 410.75. This change is also inconsistent with the coverage criteria of major insurers such as Optum12 and Aetna13, which authorize NPs to supervise TMS services in accordance with state law. We strongly encourage NGS to maintain the language authorizing NPs to supervise TMS. This coverage criteria improves access to these medically necessary services, aligns the policy with the CMS regulation of covered Medicare services provided by NPs, and promotes consistency across the Medicare program."

Thank you for the comment. We appreciate the concern regarding access to medically necessary transcranial magnetic stimulation services and the role of nurse practitioners in furnishing covered Medicare services.

Medicare coverage is available for Transcranial Magnetic Stimulation (TMS) services furnished by a nurse practitioner when the service is within the nurse practitioner’s state scope of practice, all applicable Medicare coverage requirements are met, and the service is provided under the required level of supervision. The policy does not preclude coverage of services furnished by nurse practitioners when those requirements are satisfied.

After consideration of the comment, we are maintaining language consistent with Medicare coverage requirements, including 42 CFR § 410.75, while also ensuring that applicable supervision requirements for TMS services are met. This approach supports beneficiary access to medically necessary care while maintaining alignment across the Medicare program.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33398 - Transcranial Magnetic Stimulation (Future)
Related National Coverage Documents
NCDs
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Updated On Effective Dates Status
06/18/2026 08/09/2026 - N/A Future Effective You are here

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