MCG Care Guidelines 28th edition

Effective September 1, 2024, Anthem will upgrade to the 28th edition of MCG Care Guidelines. Along with this upgrade, there will be some changes as to how transcranial magnetic stimulation (TMS) will be approved.

A specific change will be noted for Behavioral Health Care (BHG): Transcranial Magnetic Stimulation B-801-T. An annotation for motor threshold redetermination after initiation of treatment has been added to the Inconclusive or non-supportive evidence section of the evidence summary with new references to support it.

Any requests for CPT^® code 90869 will be referred for peer clinical review to determine medical necessity.

If you have questions, please contact Provider Services by calling the number on the back of the member's ID card.