Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

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TMS for treatment resistant major depressive disorder (MDD) in adult patients (age 18 or older) is a covered benefit with conditions.

Conditions of coverage:

Initial treatment (up to 30 treatment sessions) is covered when ALL of the following criteria are met:

  1. Failure of at least 2 different antidepressant medications from at least 2 separate classes at maximum tolerated dose for 4-12 weeks in separate trials, and
  2. TMS is administered according to an FDA-cleared protocol.

Repeat TMS for MDD (up to 30 treatment sessions):

  1. All of the above criteria have been met,
  2. Improvement in symptoms is maintained for at least 6 weeks following initial treatment session, and
  3. Individual has shown evidence of 30% or more improvement on the Hamilton Depression Rating Scale, OR a minimal clinically important difference on a validated scale for depression, with most recent TMS treatment.

Concurrent psychotherapy and/or antidepressant medication treatment is allowable as appropriate. Determination does not apply to age 17 and younger.

TMS is not covered for smoking cessation and for the treatment of other behavioral health disorders, including:

  • Obsessive-compulsive disorder (OCD);
  • Generalized anxiety disorder (GAD);
  • Post-traumatic stress disorder (PTSD); and
  • Substance use disorder (SUD)

Background Information

The State Health Technology Clinical Committee (HTCC) reviewed TMS for the treatment of selected conditions in March 2023 and finalized the determination in June 2023. Complete information on the HTCC determination is available at:

This coverage decision on TMS supersedes the TMS portion of a previous coverage decision (Non-pharmacologic treatments for treatment-resistant depression effective October 2014). In the previous coverage decision, TMS, along with electroconvulsive therapy, was covered for treatment-resistant depression with conditions. The previous coverage decision has been updated by removal of the contents related to TMS.

In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).