Cigna TMS Coverage: EN0383 Criteria Explained

Cigna covers an initial course of 30 to 36 TMS treatments for moderate-to-severe major depression, from age 15, under Evernorth coverage policy EN0383 (effective March 15, 2026). You need a failed trial of evidence-based psychotherapy in the current episode and, as an adult, at least two failed antidepressant trials from two separate classes; a trial counts after four weeks at an adequate dose. Cigna is also one of the few major payers that covers deep TMS for OCD. Theta burst, SAINT and other accelerated protocols are listed as experimental.

Since March 6, 2026, Evernorth no longer requires prior authorization for TMS when the provider is Evernorth-contracted; non-contracted providers still need it. Both rules are explained below. Confirm current criteria and your plan's benefit terms with Cigna before starting.

Who writes Cigna's TMS rules

Cigna's behavioral health benefits are run by Evernorth, and the TMS policy is published as Evernorth coverage policy EN0383, "Transcranial Magnetic Stimulation." The March 15, 2026 annual review made "No clinical policy statement changes"; the last substantive revision to the depression and repeat-TMS criteria came at the March 15, 2025 review. The next review is scheduled for March 15, 2027. You can read the full EN0383 policy.

Criteria for depression

For an initial course of 30 to 36 treatments, EN0383 requires all of the following:

1. A diagnosis of major depressive disorder, "moderate-to-severe, single or recurrent episode or acute relapse, without psychosis."
2. Age 15 or older.
3. During the current episode, "an adequate trial of an evidence-based psychotherapy known to be effective in the treatment of major depressive disorder, without significant improvement."
4. For adults 18 and older, "failure of two or more trials of antidepressant medications from two separate classes"; for adolescents 15 to 17, "failure of two trials of antidepressant medications," with no class requirement.
5. A validated depression scale given at the beginning and end of the course.
6. Treatment in an outpatient office setting with an FDA-cleared device (the policy itself says "FDA-approved").

What counts as a failed trial

Cigna defines a failed medication trial as an adequate therapeutic dose "for at least four weeks with no significant reduction in depressive symptoms," or "documented intolerance or medical contraindication." That is half the 8-week minimum Aetna sets, and Cigna does not require an augmentation trial. Intolerance counts, so a medication you stopped after two weeks because of side effects can still count if the reason is in the chart.

The psychotherapy requirement is the more common stumbling block. "Adequate trial" and "evidence-based" mean a structured therapy for depression, such as CBT or interpersonal therapy, not occasional supportive check-ins. If therapy happened with a different clinician, get the records, including any rating scale scores.

Teenagers aged 15 to 17

Cigna is one of the payers whose TMS policy starts at 15. For adolescents the medication rule is lighter: two failed antidepressant trials, with no requirement that they come from different classes. The psychotherapy requirement still applies, as do the rating scales at the start and end of the course.

The FDA clearances for this age group are for use "as an adjunct," meaning alongside an antidepressant, in ages 15 to 21. The data behind them are open-label registry results, and the one large sham-controlled adolescent trial did not show a benefit over sham. Coverage makes TMS possible for a teenager; it does not settle whether it is the right next step. That decision belongs in a careful conversation with a child and adolescent psychiatrist that also weighs therapy changes and medication options.

How Cigna compares

The theta burst line is worth a second look. A once-daily iTBS course was found non-inferior to standard 10 Hz rTMS in the 2018 THREE-D trial, and iTBS has been FDA-cleared since August 2018. Cigna nonetheless lists "Theta Burst Stimulation (TBS)" among the experimental accelerated protocols. If a clinic proposes iTBS and you have Cigna, ask how it will be billed and whether Cigna will pay before you start. The science is covered in theta burst stimulation explained, and the full Aetna policy in Aetna's TMS criteria.

Deep TMS for OCD

EN0383 covers an initial 30 to 36 deep TMS treatments for adults 18 and older with OCD who have failed two or more medication trials (8 weeks or more each, or intolerance), have completed an adequate trial of evidence-based psychotherapy, and are scored on the Y-BOCS at the start and end of each course. Note that the medication trial length here is 8 weeks, not the 4 weeks used for depression. A repeat course needs a greater than 30% Y-BOCS improvement at the end of the last course, maintained for at least two months. For the clinical side of OCD care, see OCD treatment and how deep TMS differs from standard TMS.

What Cigna does not cover

• Maintenance TMS: "Transcranial magnetic stimulation (TMS), used as a maintenance therapy, is considered not medically necessary."
• Accelerated protocols, named as "Theta Burst Stimulation (TBS), Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), Stanford Neuromodulation Therapy (SNT)." See what SAINT is and is not.
• The accelerated MRI-guided codes 0889T to 0892T (experimental) and the precuneus codes 0997T and 0998T (not medically necessary).
• Depression with psychosis, which is outside the covered diagnosis.

Prior authorization since March 2026

Evernorth removed the prior authorization requirement for TMS effective March 6, 2026 for Evernorth-contracted providers treating patients with Evernorth or Cigna Healthcare coverage. "Noncontracted providers must continue to obtain prior authorization for TMS." Out-of-network care remains subject to medical-necessity review, and some plans' summary plan documents may not require prior authorization even out of network, which is why Evernorth says to confirm at the benefit check.

No prior authorization does not mean no criteria. EN0383 still applies, and a claim that does not meet it can be denied after treatment. Ask the clinic whether it is contracted with Evernorth for your plan, and ask Cigna to confirm. For multiple sessions in one day, Evernorth's billing limits are one unit per day for code 90867 and two per day for codes 90868 and 90869.

If the TMS clinic is out of network

Out-of-network TMS is possible with some Cigna plans, but it comes with more steps. Evernorth says out-of-network providers remain subject to medical-necessity review, and that network exception requests still require prior authorization. Your cost share out of network is set by your plan, not by EN0383. Before the first session, ask Cigna three things: whether your plan has out-of-network behavioral health benefits, whether prior authorization is required for your plan out of network, and what you would owe per session. Get the answers with a call reference number.

Repeat courses

A repeat course for depression (another 30 to 36 treatments) requires more than 50% improvement on a standard scale at the end of the last course, maintained for at least two months. Scales must be given at the start and end of every course, so keep your own copy of your scores. Durability research is summarized in how long TMS results last.

Next steps

Gather your medication history and therapy records, then call the behavioral health number on your Cigna card to confirm your benefit, cost share and whether prior authorization applies. The prior authorization guide lists what to collect. If a claim is denied, see New York parity law and TMS claims. The TMS guide compares other insurers, and the TMS therapy page explains how a psychiatrist evaluates whether TMS fits. TMS is a weeks-long outpatient treatment, not a crisis service. 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.

Frequently asked questions

Does Cigna require therapy before covering TMS?

Yes. EN0383 requires an adequate trial of evidence-based psychotherapy for depression during the current episode, without significant improvement.

Does Cigna still require prior authorization for TMS?

Not for Evernorth-contracted providers since March 6, 2026. Non-contracted providers must still obtain it, and every claim must still meet the EN0383 criteria.

Does Cigna cover theta burst or SAINT?

No. EN0383 lists theta burst stimulation, SAINT and Stanford Neuromodulation Therapy as experimental, investigational or unproven.

Is TMS for OCD covered by Cigna?

Deep TMS for OCD is covered for adults 18 and older who meet the policy's medication, psychotherapy and Y-BOCS requirements.

How long does an antidepressant trial need to last for Cigna?

At least four weeks at an adequate therapeutic dose, or documented intolerance or a medical contraindication.

Sources

1. Transcranial Magnetic Stimulation (Coverage Policy EN0383). Evernorth Health Services (Cigna), 2026. a.static.cigna.com
2. TMS prior authorization requirement removal - FAQ for contracted providers. Evernorth Behavioral Health, 2026. campaigns.cigna.com
3. Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (Clinical Policy Bulletin 0469). Aetna, 2026. aetna.com
4. LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
5. Billing and Coding: Transcranial Magnetic Stimulation (A57528, version 5). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
6. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet, 2018. pubmed.ncbi.nlm.nih.gov
7. 510(k) K231926 (NeuroStar Advanced Therapy, adolescent indication) and 510(k) Summary. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
8. 510(k) K173620 (MagVita TMS Therapy System w/Theta Burst Stimulation). U.S. Food and Drug Administration, 2018. accessdata.fda.gov

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