States That Mandate TMS Insurance Coverage

Federal mental health parity: the foundation

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, strengthened by the ACA in 2010, is the bedrock. The idea is simple: if your insurance plan offers mental health benefits, those benefits must be on par with medical and surgical benefits.

Related: Blue Cross Blue Shield of Texas TMS Coverage · Spanish Speaking TMS Providers · State Employee Health Plan TMS Coverage

What that means in practice:

• If the plan covers medical procedures without prior authorization, it can’t require prior auth only for mental health treatments
• Deductibles, copays, and visit limits must be comparable between mental health and medical benefits
• Non-quantitative limits (like requiring medication failures before approving a procedure) can’t be applied more strictly for mental health than for medical treatments

What this means for TMS: If your insurer demands 4 failed medications before approving TMS but only requires 1 failed medication before a comparable medical procedure — say, surgery for back pain after failing physical therapy — that’s likely a parity violation.

This is a real lever. Use it.

States with strong TMS-relevant protections

No state mandates TMS coverage by name. But several have mental health coverage laws that make it much harder for insurers to deny you.

States with strong mental health mandates

California

• Requires coverage of all “medically necessary” mental health treatments
• SB 855 (2020) mandates that insurers use generally accepted standards of care — not their own restrictive criteria
• The Department of Managed Health Care actively enforces parity
• File complaints at: dmhc.ca.gov

Colorado

• HB 19-1269 strengthened parity enforcement and required annual compliance reports from insurers
• Colorado Division of Insurance investigates parity complaints
• File complaints at: doi.colorado.gov

Connecticut

• One of the earliest and strongest mental health parity states
• Requires coverage of “biologically based mental illness” including depression
• Insurance commissioner has enforcement authority
• File complaints at: portal.ct.gov/CID

Illinois

• Mental Health and Developmental Disabilities Code requires broad coverage
• Covers TMS explicitly when medically necessary for treatment-resistant depression
• File complaints at: insurance.illinois.gov

Maryland

• Mental Health Parity Compliance law with a dedicated enforcement unit
• Maryland Insurance Administration conducts proactive parity audits — they don’t wait for complaints
• File complaints at: insurance.maryland.gov

Massachusetts

• Requires coverage for all “biologically based” mental disorders
• Division of Insurance has a dedicated mental health parity complaint process
• File complaints at: mass.gov/doi

New York

• Timothy’s Law requires broad mental health coverage
• DFS (Department of Financial Services) enforces parity aggressively
• File complaints at: dfs.ny.gov

Oregon

• ORS 743A.168 mandates mental health coverage at parity
• Oregon Division of Financial Regulation oversees compliance
• File complaints at: dfr.oregon.gov

See also: TMS Coverage by Major Insurance Providers in 2026 · Psilocybin-Assisted Therapy

How to use parity law when denied TMS

Your TMS claim was denied. Here’s how parity law gives you specific tools to push back.

Step 1: Request the parity comparison

Ask your insurer in writing: “Please provide the comparable medical/surgical treatment limitation and explain how the limitation applied to my TMS request complies with MHPAEA.”

They’re legally required to respond. The answer often reveals the disparity on its own.

Step 2: Spot the disparity

Common parity violations in TMS denials:

• Medication failure requirements: Plan requires 4 failed antidepressants before TMS but only 1 failed medication before comparable medical procedures
• Prior authorization burden: TMS requires extensive documentation that comparable outpatient medical procedures don’t
• Session limits: Plan caps TMS sessions but doesn’t cap comparable medical treatment series (like physical therapy)

Step 3: File a parity complaint

File simultaneously with:

1. Your insurer’s internal appeals department — citing specific parity violations
2. Your state insurance commissioner — using the contacts above
3. CMS (for employer-sponsored plans under ERISA): dol.gov/agencies/ebsa
4. Your state attorney general — if the insurer doesn’t respond to the parity request

Filing in multiple places at once creates pressure. That’s the point.

State insurance commissioner contacts

Every state has an insurance commissioner who handles consumer complaints. Key contacts for common TMS states:

For other states, search “[your state] department of insurance complaint” to find the filing portal.

See also: Hindi Speaking TMS Providers · The Real Cost of TMS Therapy in 2026: City-by-City Breakdown

Self-insured employer plans: a different path

If your employer self-insures (common at large companies), state laws don’t apply to your plan. Federal law (ERISA) governs instead.

But:

• Federal MHPAEA parity law still applies
• File complaints with the Department of Labor, Employee Benefits Security Administration (EBSA) at dol.gov/agencies/ebsa
• Request your plan’s Summary Plan Description (SPD) and any Clinical Coverage Policies related to TMS
• Self-insured plans sometimes have more flexibility to approve TMS case by case. Talk to your HR department — they have more influence over what the plan covers than you might think

Where TMS coverage is headed

TMS coverage has expanded dramatically since 2018. Every major insurer now covers TMS for depression. Most state Medicaid programs include it. The direction is clear:

• Broader covered diagnoses (OCD is increasingly covered; PTSD and anxiety are under review)
• Fewer medication failure requirements (moving from 4 to 2 failed trials)
• Faster authorization timelines
• State legislation specifically naming TMS as a required benefit — watch for bills in California, New York, and Illinois in upcoming sessions

The system is moving toward more coverage, not less. If you’re fighting for approval right now, the trend is on your side.

See also: Mandarin Speaking TMS Providers · How TMS Gave Me My Life Back After 10 Years of Depression

How to Get TMS Approved

What If You’re Denied?

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