Aetna TMS Coverage: CPB 0469 Criteria Explained

Aetna covers TMS for severe major depression without psychosis under Clinical Policy Bulletin 0469, last reviewed July 17, 2026. Adults need two failed antidepressants from two different classes, each taken for at least 8 weeks, plus at least 8 weeks of an augmentation medication. Teenagers aged 15 to 17 can qualify under separate rules. A course is capped at 30 sessions plus 6 tapering sessions, and accelerated protocols such as SAINT, maintenance TMS and TMS for OCD are treated as experimental.

Aetna's medication requirement is one of the most demanding among major insurers, while its psychotherapy requirement for adults is one of the lightest. Here is the policy in detail, with the points where it differs from other payers. Aetna revises this bulletin regularly (the next scheduled review is May 13, 2027), so confirm the current version with your plan.

CPB 0469 at a glance

Adults: the medication rule in detail

For members 18 and older, Aetna asks for an inadequate response to "Two antidepressants from at least 2 different classes ... at the maximally tolerated labeled dose, each used for at least 8 weeks" and to "Augmentation therapy used in combination with a primary antidepressant for at least 8 weeks." Augmentation means adding a second medication to an antidepressant; the bulletin's appendix gives examples that include a second antidepressant with a different mechanism, a second-generation antipsychotic FDA-approved for augmentation, lithium and thyroid hormone (T3).

Three details trip people up:

• Two medications from the same class, such as two SSRIs, count as only one class.
• Eight weeks per trial at the maximally tolerated labeled dose is a high bar. If a trial ended sooner because of side effects, your psychiatrist should document the dose, the dates and the reason.
• The trials must fall within the current episode, and that episode must be within the past 5 years.

The bulletin does not require adults to have tried psychotherapy first. That is a real difference from Cigna and from New York Medicare, both of which require a failed psychotherapy trial (see Cigna's TMS criteria and Medicare in New York). Good care still usually includes therapy; the policy simply does not make it a gate. For how other payers count medication trials, see how many antidepressants plans expect you to try.

Teenagers aged 15 to 17

Aetna is one of the payers that reaches below 18. For adolescents, TMS is covered as an add-on to an antidepressant, not a replacement. The teen must have had an inadequate response to two antidepressant trials of 8 weeks or more, and also at least one of: an evidence-based psychotherapy such as CBT or IPT, or 8 weeks or more of augmentation.

That structure tracks the FDA labeling. The adolescent clearances, the first in March 2024, are for use "as an adjunct" in ages 15 to 21. The evidence behind them comes from open-label registry data rather than a positive sham-controlled trial, and the sham-controlled adolescent trial (Croarkin 2021) was negative. TMS for a teenager deserves a careful conversation with a child and adolescent psychiatrist about the evidence and the alternatives.

What Aetna calls experimental

CPB 0469 draws its lines by protocol, not just by device. Standard daily rTMS and iTBS on an FDA-cleared device are covered. These are listed as experimental or investigational:

• "Accelerated TMS, as well as, MRI-guided TMS," including SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy), and the accelerated codes 0889T to 0892T.
• Ketamine given alongside TMS.
• Maintenance TMS, defined as anything outside the 30-plus-6 course.
• TMS for OCD, PTSD, bipolar and other mood disorders besides MDD, MDD with psychosis, anxiety disorders and smoking cessation.

Note the gap between FDA status and coverage. Several accelerated protocols are now FDA-cleared, including BrainsWay's in 2025 and MagVenture's in 2026, alongside SAINT. Clearance means a device may be marketed; it does not oblige an insurer to pay. Background on the protocols is in accelerated TMS explained and what SAINT is and is not.

Deep TMS for depression is not separately excluded, provided the device is FDA-cleared for MDD. Aetna also says there is no evidence that someone who fails one TMS brand will respond to another brand, theta burst or a deep TMS device. In practice, switching devices after a failed course is unlikely to be approved. The trade-offs between coils are covered in deep TMS versus standard TMS.

Who is excluded

Aetna does not cover TMS for people with any of these:

• Substance abuse in the last 90 days
• Active suicidality
• Metal implants or fragments in or around the head, or other implanted devices
• Certain neurological conditions
• Severe cardiovascular disease, unless a cardiologist clears treatment
• Head or neck tattoos with ferromagnetic ink
• Unstable medical disorders

The active-suicidality exclusion reflects that TMS takes weeks and is not an emergency treatment. If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.

Who orders, and how the course runs

The order must come from a psychiatrist (MD or DO) or a psychiatric-mental health nurse practitioner, who provides direct supervision, and the TMS operator must be in the room throughout. The course is "a maximum of 30 sessions (5 days a week for 6 weeks) plus 6 tapering sessions (6 sessions over three weeks)," and anything beyond 36 may be reviewed for medical necessity. One re-mapping of the motor threshold per course is covered, more if you are not responding or your threshold may have changed, and re-mapping does not add sessions. The same rating scale must be used from baseline to the end of the course. For why the threshold matters, see motor threshold and TMS dosing.

A second course after relapse

Retreatment can be covered if you met the original criteria, relapsed despite other treatment, and the earlier course produced "at least a 50% reduction in depressive symptoms" that lasted "for at least two months." A repeat course "within 60 days following the termination of the prior TMS course is considered not medically necessary."

Building the record before the request

Most Aetna TMS requests succeed or fail on paperwork. The bulletin's own criteria point to what reviewers look for:

• A baseline score on a validated scale such as the BDI, HDRS or MADRS from the current episode, and a plan to use the same scale throughout.
• Each antidepressant by name, class, dose, start and stop dates, and the result.
• The augmentation trial, with the same detail.
• A psychiatrist's confirmation of the diagnosis, and a screen for each exclusion above.

If records from earlier prescribers are missing, request them before the TMS consultation, not after a denial.

What the bulletin does not tell you

CPB 0469 sets clinical criteria. It does not tell you whether your specific plan requires prior authorization for TMS, what your deductible or coinsurance will be, or which TMS clinics participate in your network; those were not verified for this page. Self-funded employer plans administered by Aetna can also have their own benefit terms. To find out:

1. Call the member services number on your card and ask whether CPT 90867 and 90868 need prior authorization under your plan.
2. Ask for your cost share for outpatient behavioral health procedures, in and out of network.
3. Ask the TMS clinic to verify its network status with your plan directly.

The documentation to gather in advance is listed in the prior authorization guide. If a request is denied, New York's parity and appeal rights are in New York parity law and TMS claims. The full TMS guide compares other insurers, and the TMS therapy page explains how a psychiatrist decides whether TMS is the right step at all.

You can read the full policy on Aetna's Clinical Policy Bulletin 0469 page.

Frequently asked questions

Does Aetna require therapy before TMS?

Not for adults. CPB 0469 has no psychotherapy-trial requirement for members 18 and older. For teenagers aged 15 to 17, a psychotherapy trial is one of two ways to meet the criteria.

Does Aetna cover theta burst (iTBS) TMS?

Yes, when it is given on an FDA-cleared device. Accelerated protocols, including SAINT and other MRI-guided accelerated schedules, are listed as experimental.

Does Aetna cover TMS for OCD?

No. CPB 0469 lists obsessive-compulsive disorder among the conditions for which TMS is considered experimental.

How many TMS sessions will Aetna pay for?

Up to 30 sessions over 6 weeks plus 6 tapering sessions over 3 weeks. Sessions beyond 36 may be reviewed for medical necessity, and maintenance TMS is considered experimental.

Can I switch to a different TMS device if the first course did not work?

Aetna states there is no evidence that people who fail one TMS brand respond to another brand, theta burst or a deep TMS device, so a switch after a failed course is unlikely to be approved.

Sources

1. Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
2. Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com
3. LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
4. 510(k) K231926 (NeuroStar Advanced Therapy, adolescent indication) and 510(k) Summary. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
5. 510(k) K260189 (MagVenture Accelerated TMS Therapy System) and 510(k) Summary. U.S. Food and Drug Administration, 2026. accessdata.fda.gov
6. 510(k) K220177 (Magnus Neuromodulation System with SAINT Technology). U.S. Food and Drug Administration, 2022. accessdata.fda.gov
7. Transcranial Magnetic Stimulation for Treating Physical Health Conditions (CPT code descriptors). UnitedHealthcare, 2026. uhcprovider.com

Educational information, not medical advice. Whether TMS or any treatment fits you is a decision to make with a psychiatrist who knows your history.