Optum Behavioral Health Solutions says its 2026 TMS policy applies to people 15 and older with confirmed major depressive disorder, subject to stated criteria.
Optum policy update
Optum Behavioral Health Solutions states that its behavioral clinical policy BH803TMS112025 considers transcranial magnetic stimulation, or TMS, proven and medically necessary for confirmed major depressive disorder. The source lists an annual review dated November 18, 2025, and an interim review dated April 21, 2026.
The policy change is effective January 1, 2026, according to Optum Behavioral Health Solutions. The source describes this as an update to the age group covered by the policy’s TMS criteria.
Age eligibility
According to Optum Behavioral Health Solutions, the policy applies to individuals age 15 and older beginning January 1, 2026. Before that effective date, the policy applied to individuals age 18 and older.
The source therefore identifies people ages 15 through 17 as included in the policy’s TMS criteria starting in 2026. Optum Behavioral Health Solutions also sets separate criteria language for this age group and for adults.
Criteria in the policy
For people ages 15 through 17, Optum Behavioral Health Solutions states that the policy requires a lack of response to, or inability to tolerate, two evidence-based medication trials during the current depressive episode.
For adults, the source states that the policy requires two medication trials. Optum Behavioral Health Solutions identifies confirmed major depressive disorder as the condition addressed by the TMS policy.
Policy scope
Optum Behavioral Health Solutions says the criteria apply across all lines of business unless federal or state regulation supersedes them. The source does not describe a change to that general scope in the extract provided.
The policy language cited by Optum Behavioral Health Solutions is a coverage and clinical-policy standard. Its stated criteria include age, confirmed major depressive disorder, and medication-trial requirements.
What this means for Tennessee patients
For Tennessee residents looking for local treatment information, this directory lists 97 published clinics in Tennessee. Optum Behavioral Health Solutions’ policy update identifies age 15 as the starting point for its TMS criteria effective in 2026, while stating that other federal or state rules may supersede its criteria.
This is general information, not medical advice.
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This report is educational and is not medical advice. Coverage, availability and eligibility can change; verify details with the named source or your care team.