Optum coverage for TMS therapy
We work with Optum plans for TMS therapy, Spravato, medication management, and psychotherapy. We verify your specific coverage within one business day — before you commit.
Optum coverage details
Optum Behavioral Health is the behavioral health administrator inside UnitedHealth Group, managing mental health benefits for most UnitedHealthcare commercial, Medicare Advantage, and employer-sponsored plans, as well as for a number of carve-out contracts with other payers and public programs. If your UnitedHealthcare card lists Optum as the behavioral health network, Optum is the entity that authorizes and pays for psychiatric care including Transcranial Magnetic Stimulation. Optum's medical-necessity criteria recognize TMS as appropriate for adults with treatment-resistant major depressive disorder, consistent with FDA clearances and the 2024 CMS National Coverage Determination.
What Optum typically covers
- Adult psychiatry and medication management — evaluations, follow-ups, prescription oversight
- TMS therapy for FDA-cleared indications — MDD/treatment-resistant depression
- Outpatient psychotherapy — individual sessions with in-network behavioral health providers
Optum's clinical criteria sit on top of the underlying medical plan's benefit design. Two members with Optum behavioral health can still have different copays and session caps based on the medical plan their employer purchased.
Prior authorization for TMS
A standard TMS course runs 36 sessions over six to nine weeks. Optum requires prior authorization before the first session and typically requests:
- DSM-5 diagnosis of major depressive disorder
- Documented failure of at least two antidepressants at therapeutic dose and duration from at least two pharmacologic classes
- Baseline severity score (PHQ-9, HAM-D, BDI, or equivalent)
- Documented psychotherapy trial or clinical justification for omission
- No contraindications to magnetic stimulation
Optum frequently requires interim severity re-scoring around session 20 to authorize the remainder of the course. Our team handles the initial submission and any concurrent review. Initial determinations typically arrive within 5 to 14 business days.
Verifying your specific plan
Optum administers behavioral health for dozens of different underlying plans, so what your card says is only the starting point. Session caps, copay tied to the medical plan, and the specific Optum portal used for authorization all depend on the product. Real-time verification against your member ID is the only way to know your coverage with certainty.
Verify Your Coverage
Not sure if your plan covers TMS at Healing TMS Clinic?
Send us your insurance card and date of birth via our secure verification form. Our team responds within 1 business day with the exact coverage, prior-authorization requirements, and your estimated out-of-pocket cost.
Other services covered
About Healing TMS Clinic
Healing TMS Clinic is a psychiatric outpatient practice at 5475 East La Palma Avenue, Suite 204, Anaheim, CA 92807. We serve patients throughout Orange County, North Long Beach, the San Gabriel Valley, and the Inland Empire within a 30-mile service radius. Call (657) 656-5611 to begin verification or schedule a clinical consultation.
Other carriers we work with
Find out if TMS is covered for you.
Insurance verification takes about two minutes. We'll tell you whether your plan covers TMS for treatment-resistant depression and what your cost will be — before you book anything.
Monday–Friday, 9:00 AM – 5:00 PM