Medicare Coverage for TMS in New York: LCD L33398 Explained

Yes. Original Medicare covers TMS in New York for adults with major depressive disorder when the criteria in Local Coverage Determination L33398, "Transcranial Magnetic Stimulation," are met. The current version is version 40, with a revision effective August 9, 2026; the policy itself dates from October 1, 2015. In short, Medicare expects a confirmed diagnosis of major depression, a failed or poorly tolerated medication trial, a failed course of evidence-based psychotherapy, and a physician who orders and supervises the treatment.

Medicare rules for TMS are set regionally, not nationally, so a New Yorker reading a Florida or Texas clinic's summary can easily get the wrong answer. This page walks through the New York policy line by line. Policies change, so confirm the current version with Medicare or your plan before you start.

Which Medicare policy applies in New York

New York belongs to Medicare Jurisdiction K, together with Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The contractor for Jurisdiction K has been National Government Services (NGS), which began operating under the name Wellpoint Federal on April 1, 2026. The LCD's revision history states that this was a name change only and that "There are no changes to coverage."

Two documents matter:

• LCD L33398, which sets out who qualifies and what is considered reasonable and necessary.
• Billing and Coding Article A57528 (version 5, effective April 1, 2026), which lists the diagnosis codes, the rating scales, and documentation rules.

Other Medicare contractors publish their own TMS policies, for example Novitas L34998 and Noridian L37086, and their criteria differ. If you split your year between New York and another state, ask the clinic which contractor's policy its claims fall under. You can read the New York policy yourself in the CMS Medicare Coverage Database.

The coverage criteria, one by one

L33398 limits coverage to adults "who have a confirmed diagnosis of major depressive disorder (MDD), single or recurrent episode." The billing article narrows that further to two diagnosis codes: F32.2 and F33.2, both meaning severe major depression without psychotic features. Medicare then asks for at least one route through the medication requirement, plus a psychotherapy trial.

The medication requirement is narrower than many people expect

The policy reads: "lack of a clinically significant response to one trial of psychopharmacologic agents in the current depressive episode from at least two different agent classes." Each agent must have been given at an adequate course. In practice that describes one treatment trial, which might be an antidepressant combined with an agent from another class, rather than a long list of failed medications. A 2018 revision note confirms the change: it allowed rTMS "after one failed pharmacologic therapy (versus the current four)." Older articles that say Medicare requires four failed medications describe the pre-2018 rule.

If side effects stopped you from staying on medication, the separate intolerance route applies: two trials from at least two classes, each with distinct side effects. For the broader picture of how many medications payers ask for, see how many antidepressants plans expect you to try first.

The psychotherapy requirement is firm

Unlike some commercial plans, the New York Medicare policy requires a trial of evidence-based psychotherapy "of an adequate frequency and duration without significant improvement in depressive symptoms as documented by standardized rating scales." This is an "and," not an "or." If you have only had supportive counseling, or therapy without scores recorded, talk with your psychiatrist about what the record actually shows before a request is filed.

Who can order and supervise

A physician (MD or DO) with TMS experience writes the order and directly supervises the course. Nurse practitioners and other non-physician practitioners may order treatment or retreatment where that is within their state scope of practice. The August 9, 2026 revision removed a sentence that had allowed NPP supervision, to make clear that supervision must come from a physician. Why that oversight matters clinically is covered in who delivers TMS and why supervision matters.

What New York Medicare does not cover

• Maintenance TMS. The LCD says maintenance therapy "is not currently supported by evidence from clinical trials and therefore, is considered not reasonable and necessary." The billing article repeats: "Maintenance therapy is not covered."
• Deep TMS for obsessive-compulsive disorder, which the LCD names as not reasonable and necessary. TMS for OCD and other non-MDD conditions is outside the two covered codes.
• Depression with psychotic features in the current episode, which the LCD lists among its cautions. Psychotic-feature codes are not among the covered diagnoses.

The LCD also lists cautions that may rule TMS out: a history of seizures (other than ECT-induced or isolated infant febrile seizures), certain neurological conditions, and implanted magnetic-sensitive devices within 30 cm of the coil, such as a pacemaker, cochlear implant or VNS. Dental amalgam fillings are acceptable.

Some questions the LCD simply does not answer. It sets no numeric severity cut-off on a rating scale, no fixed session count, and does not mention theta burst, iTBS or accelerated TMS by name. Silence is not the same as coverage. Whether a theta burst or accelerated schedule would be paid under Medicare is a question to put to the billing team and, if needed, the contractor before treatment starts.

Sessions, rating scales and documentation

Because the policy has no session cap, the billing article relies on review instead: "Services performed in excess of established parameters may be subject to review for medical necessity." The treatment-planning code 90867 may be reported once per treatment episode.

Measurement is central. The attending physician must use a validated depression scale, such as the PHQ-9, BDI, HAM-D, MADRS, QIDS, IDS-SR or the Geriatric Depression Scale, to track response and remission, and must document your progress during treatment. Records must support medical necessity and carry legible signatures. For what those scores mean, see response versus remission.

A record that will hold up typically includes:

1. The diagnosis, with severity, and why other causes were considered.
2. The medication trial or trials: names, doses, dates and the outcome, or the side effects that ended them.
3. The psychotherapy trial, with type, frequency, duration and before-and-after scale scores.
4. A screen for the LCD's cautions, including seizures and implanted devices.
5. The order from the supervising physician.

Retreatment after a relapse

A second course may be considered if you met the criteria the first time, then relapsed, and the first course produced "a greater than 50% improvement in standard rating scale measurements." The billing article also allows retreatment after a relapse that follows remission. That is one reason baseline and end-of-course scores matter so much: without them, a future retreatment request has nothing to stand on. The research on how long benefit tends to last is in how long TMS results last.

What you pay under Original Medicare

TMS is an outpatient service under Part B. For 2026 the standard Part B premium is $202.90 a month and the annual deductible is $283; after that you usually pay 20% of the Medicare-approved amount when the provider accepts assignment. A daily course adds up, so supplemental (Medigap) coverage or Medicaid, if you have it, makes a large difference. This page does not give a per-session Medicare payment amount, because that figure was not verified against the fee schedule; ask the clinic for an estimate in writing.

Medicare Advantage plans in New York

If you have a Medicare Advantage plan, the plan, not Original Medicare, handles the request. Under CMS rule CMS-4201-F, Advantage plans "must comply with national coverage determinations (NCD), local coverage determinations (LCD)," and may use their own criteria only "when coverage criteria are not fully established." For a New Yorker that means L33398 is the floor. One example: Optum's Medicare coverage summary for TMS reproduces the L33398 criteria for New York.

If your Advantage plan requires prior authorization for TMS, federal rules shape that process:

• Since January 1, 2026, plans must decide within 7 calendar days for standard requests and 72 hours for urgent ones, and must give a specific reason for a denial.
• An approval for a course of treatment must remain valid "for as long as medically reasonable and necessary."
• If you switch Advantage plans mid-course, coordinated care plans must give at least a 90-day transition period.

Network rules, copays and which TMS clinics a plan contracts with vary by plan. Call the member services number on your card, and ask the TMS clinic to confirm its status with your specific plan. The step-by-step process is in TMS prior authorization, step by step.

Before you start: questions worth asking

• Is my diagnosis documented as severe MDD without psychotic features, and does my record show it?
• Does my chart show a psychotherapy trial with rating scale scores?
• Who is the supervising physician, and will the protocol follow the device's cleared labeling?
• If I have Medicare Advantage, has the plan approved the request in writing, and for how many sessions?
• What will I owe after Part B and any supplemental coverage?

If a claim or request is denied, you have appeal rights; New York's state appeal rules and parity law are covered in New York parity law and TMS claims, and the TMS guide collects the rest of the coverage pages, including New York Medicaid for people with both Medicare and Medicaid. For how a psychiatrist evaluates whether TMS fits at all, see TMS therapy in Brooklyn.

TMS is not the right first step for everyone. Medicare's own criteria assume medication and psychotherapy have been tried first, and acute safety comes before any course of 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.

Frequently asked questions

Does Medicare require four failed antidepressants before TMS in New York?

No. That was the pre-2018 rule. The current New York policy, LCD L33398, asks for one failed trial using agents from at least two classes, or one of three other routes such as intolerance of two trials, plus a failed psychotherapy trial.

Does Medicare cover TMS for OCD?

Not in New York. LCD L33398 states that deep TMS is not considered reasonable and necessary for obsessive-compulsive disorder, and the billing article covers only two major depression codes.

Will Medicare pay for maintenance or booster TMS sessions?

No. Both the LCD and the billing article say maintenance therapy is not covered. A new course after a relapse can be considered if the first course produced more than 50% improvement on a standard rating scale.

Can a nurse practitioner order TMS under Medicare in New York?

A non-physician practitioner may order treatment if that is within their state scope of practice, but since the August 9, 2026 revision the treatment must be supervised by a physician (MD or DO).

Is there an age limit?

The New York LCD covers adults only.

Does Medicare Advantage follow the same rules?

Advantage plans must follow the local coverage determination, so L33398 is the minimum standard in New York. They can add prior authorization and their own network and copay rules, so confirm the details with your plan.

Sources

1. LCD L33398 Transcranial Magnetic Stimulation (version 40). Wellpoint Federal (formerly National Government Services), CMS Medicare Coverage Database, 2026. cms.gov
2. Billing and Coding: Transcranial Magnetic Stimulation (A57528, version 5). Wellpoint Federal, CMS Medicare Coverage Database, 2026. cms.gov
3. Medicare Administrative Contractors (MACs) by State. Centers for Medicare & Medicaid Services, 2023. cms.gov
4. NGS to begin operating under new name. American Podiatric Medical Association, 2026. apma.org
5. Local Coverage Final LCDs report. CMS Coverage API, 2026. api.coverage.cms.gov
6. Medicare costs. Medicare.gov (CMS), 2026. medicare.gov
7. 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F) fact sheet. Centers for Medicare & Medicaid Services, 2023. cms.gov
8. CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) fact sheet. Centers for Medicare & Medicaid Services, 2024. cms.gov
9. Optum Medicare Coverage Summary: Transcranial Magnetic Stimulation. Optum Behavioral Health Solutions, 2025. providerexpress.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.