Cigna TMS Coverage

Yes

Covers TMS

Required

Prior Authorization

$500-$2,500

Typical patient cost

Cigna’s coverage

Cigna (now Cigna Evernorth) covers TMS for treatment-resistant major depressive disorder. Prior authorization is required.

Good news: Cigna’s criteria are among the more reasonable out there.

What Cigna requires

Diagnosis: Major Depressive Disorder, moderate to severe
Failed medications: At least 2 antidepressants from different classes, each at adequate dose for at least 8 weeks
Current severity: Documented with a standardized scale — PHQ-9, HAM-D, or BDI
Provider: In-network TMS provider with appropriate credentials

Two failed meds. That’s the standard threshold, and Cigna sticks to it.

Session limits

Cigna typically authorizes:

Acute phase: Up to 36 sessions
Maintenance: May need separate authorization. Your provider should document any symptom return with updated depression scores

What you’ll pay

Depends on your plan:

Cigna PPO (in-network): $500-$2,500 total after deductible
Cigna HMO: Lower cost, but more hoops — you’ll need a referral from your PCP to a psychiatrist to TMS
High-deductible / HSA plans: Full cost until your deductible is met, then coinsurance. You can use HSA/FSA funds for copays and coinsurance

Tips for approval

Submit PHQ-9 scores at baseline. Cigna wants numbers, not just “patient is depressed”
Include a letter of medical necessity from your prescribing psychiatrist
Document each failed medication: dates, doses, how long you took it, and why it didn’t work
If denied, appeal with more documentation. Cigna’s first-level appeal success rate for TMS runs about 40-50% — same as other major insurers

The theme here? Document everything. Cigna rewards thorough paperwork.

Related Insurance Guides

Medicare Coverage BCBS Coverage Prior Auth Guide TMS Cost Guide

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How to Get TMS Approved

Verify Benefits

Call the number on the back of your insurance card and ask specifically about TMS therapy coverage. Get a reference number.

Get Your Documentation Ready

Gather records of your MDD diagnosis, all medication trials (names, doses, durations, outcomes), current PHQ-9 score, and therapy history.

Choose a TMS Clinic

Find an in-network TMS provider using our clinic directory. In-network clinics handle prior auth and know your insurer's requirements.

Prior Authorization

Your TMS clinic submits the prior auth request. Typical approval takes 5-15 business days. If denied, appeal — overturn rates are 60-70%.

What If You’re Denied?

Don't give up after a denial

TMS denial overturn rates are 60-70% on appeal. Steps to take:

Request a peer-to-peer review — your psychiatrist talks directly to the insurer's medical director
Submit additional documentation addressing the specific denial reason
File a formal appeal with your state insurance department if internal appeals fail
External review — most states allow independent external review of coverage denials

For more details, see our Prior Authorization Guide and Denied Coverage Appeals guide.