LCD Reference Article Response To Comments Article

Response to Comments: Transcranial Magnetic Stimulation (TMS)

A59443

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Source Article ID
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Article ID
A59443
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Transcranial Magnetic Stimulation (TMS)
Article Type
Response to Comments
Original Effective Date
08/20/2023
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Article Text

Noridian's Response to Provider Recommendations for Transcranial Magnetic Stimulation (TMS) (for comment period ending 03/25/2023). 

Response To Comments

Number Comment Response
1

Multiple comments were received requesting expansion of prescribing and direction of TMS therapy for coverage and reimbursement to non-physician practitioners, especially those providing healthcare in poorly served areas. 

Noridian has no evidence to support the provision of TMS therapy has been studied or therapeutically provided to Beneficiaries with safe and effective outcomes by other than licensed psychiatrists training in the evaluation and provision of TMS therapy. Recommendations for prescription, direction and provision of TMS therapy by licensed physicians trained in an inclusive program or credentialed by a nationally recognized training program will remain in place in the jurisdictional LCD for TMS therapy.

2

Suggestion has been made by several commentors for LCD provision of coverage and reimbursement in the treatment of obsessive-compulsive disorder (OCD), including recommendations for criteria and limitations.

Literature review in additional to comments have failed to demonstrate substantial and reliable evidence in the form of peer-reviewed literature and/or RCT case studies demonstrating safety and benefit to TMS therapy for obsessive compulsive disorder. While it is acknowledged this entity is still under debate by multiple entities, Noridian will refrain from extending coverage for suggested OCD until substantiating evidence of safety and effectiveness is conclusively demonstrated.

3

Comment has been submitted requesting increase in fee schedule reimbursement for TMS services.

Unfortunately, Noridian cannot alter CMS prescribed fee schedule for Category I codes. Differences in cited reimbursement on the CMS Fee schedule are based on geographical location variables determined by CMS.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
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