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November 2025 Top of Mind

NYS Medicaid Now Covering TMS

Eligible members diagnosed with treatment-resistant major depressive disorder (MDD) have a new treatment option. Starting Nov. 1, 2025, New York State Medicaid began covering Transcranial Magnetic Stimulation (TMS) therapy.

Eligibility requirements

  • Enrolled in Medicaid Managed Plan
  • Members 18 years of age and older
  • Patients must be diagnosed with treatment resistant MDD
    • Eligible diagnosis – MDD (F32.2, F33.2)
  • Must rule out other etiologies of depressive symptoms that can interfere with medication effectiveness
  • Services must be performed by a qualified psychiatrist with specialized training and certification

TMS is available for members who received two trials of two different antidepressants, at therapeutic doses, for a sufficient duration without achieving a clinically meaningful response.

Putting it into practice
Prior to treatment, you’ll need to obtain prior authorization in one of two ways:

  • Go to ProviderExpress.com and select Log In to access the Provider Express secure portal and  request prior authorization using your One Healthcare ID. Don’t have one? Choose First-time User on the login page to create one. Follow these steps to request prior authorization:

    1. Select Auth from the menu
    2. Choose Review Online
    3. Complete the request
  • Phone – Call Provider Services at 1-866-362-3368 (the number on the back of the member ID card) and follow the prompts

To help avoid payment delays, use the appropriate CPT code:

CPT Code Description
90867 Therapeutic repetitive TMS initial planning visit; includes initial procedures such as cortical mapping, motor threshold determination, delivery, and management.
90868 Therapeutic repetitive TMS treatment; subsequent delivery and management per session.
90869 Re-determination of motor threshold during TMS. This code is used for subsequent assessments of the motor threshold, which is the minimum intensity of electrical pulses required to elicit a desired response in brain activity.

If you’re a qualified psychiatrist with specialized training and certification in TMS, please contact Provider Services at 1-877-614-0484 to ensure it’s listed as an Area of Expertise.

Want to know more?
Explore additional information in the New York State Medicaid Update July 2025 Volume 41 Number 7.

If you have further questions, you may contact your Provider Relations Advocate.


 

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