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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at42 Code of Federal Regulations (CFR) Section 422.101.The rules say that repetitive transcranial magnetic stimulation (rTMS) is only considered medically necessary in adults who have a confirmed diagnosis of major depressive disorder (MDD), single or recurrent episode and meet the following criteria:-Resistance to treatment as evidenced by a lack of a clinically significant response to four (4) trials of psychopharmacologic agents in the current depressive episode -Two different agent classes, at or above the minimum effective dose and duration and includes trials of at least two (2) evidence-based augmentation therapies; or-Inability to tolerate psychopharmacologic agents as evidenced by four (4) trials of psychopharmacologic agents with distinct side effects; orHistory of response to rTMS in a previous depressive episode; or-History of response to electroconvulsive therapy (ECT) in a previous or current MDD episode, or inability to tolerate ECT, and rTMS is considered a less invasive treatment option; and-A trial of an evidence-based psychotherapy known to be effective in the treatment of MDD of an adequate frequency and duration without significant improvement in depressive symptoms as documented by standardized rating scales that reliably measuredepressive symptoms; and-The rTMS treatment is delivered by a device that is FDA-approved or -cleared for the treatment of MDD in a safe and effective manner. rTMS treatment should generally follow the protocol and parameters specified in the manufacturer's user manual, with modifications only as supported by the published scientific evidence base; and-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 rTMS 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 availableYou can find this rule in Local Coverage Determination (LCD): Transcranial Magnetic Stimulation (L33398) -Effective October 1, 2020.The rules say that TMS is not considered reasonable and necessary for any of the following:-Presence of psychotic symptoms in the current depressive episode;-Acute or chronic psychotic disorder such as schizophrenia, schizophreniform disorder, or schizoaffective disorder, or any other neuropsychiatric disorder;-Neurologic conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, having a history of repetitive or severe head trauma, or with primary or secondary tumors in the central nervous system;-Persons with conductive, ferromagnetic or other magnetic-sensitive metals implanted in their head which are non-removable and within 30 cm of the TMS magnetic coil. Examples include cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils stents, and bullet fragments. (Dental amalgam fillings are not affected by the magnetic field and are acceptable for use with TMS.)-Maintenance therapy is not currently supported by evidence from clinical trials and therefore, is considered not reasonable and necessary.-All other conditions not included in the above list of "Indications."You can find this rule in Local Coverage Determination (LCD):Transcranial Magnetic Stimulation (L33398) -Effective October 1, 2020.If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.The Plan contract says that the Plancovers items and services in accordance with Medicare rules.