Cigna (through Evernorth) is removing prior authorization requirements for Transcranial Magnetic Stimulation (TMS) for in-network providers, effective for dates of service beginning March 6, 2026.
According to Evernorth’s official provider update, prior authorization will no longer be required for TMS when services are performed by contracted providers for eligible members.
For many clinics, this represents one of the most meaningful payer policy shifts in recent years for TMS access. Prior authorization has historically been one of the largest bottlenecks between consult and treatment start. This change removes that step for eligible patients and providers — but it does not remove the need for eligibility verification, medical necessity documentation, or strong operational workflows.
If you are new to how payer access impacts TMS growth and patient start rates, you can read more here.
What Changed in Cigna’s TMS Prior Authorization Policy
Beginning March 6, 2026:
- Prior authorization is no longer required for TMS
- Applies to Evernorth / Cigna behavioral health plans
- Applies to contracted (in-network) providers
- Applies to dates of service starting March 6, 2026 and forward
Prior authorization requirements may still apply to:
- Out-of-network providers
- Services rendered prior to March 6, 2026
- Certain plan-specific network or geographic limitations
- Clinics should continue verifying patient eligibility and benefits before starting treatment.
This is part of an overarching behavioral health access initiative by The Cigna Group to reduce friction and increase access to mental health care.
What This Means for Clinics Starting March 6
If a patient is:
✔ In-network with your clinic
✔ Active and eligible under their Cigna / Evernorth behavioral health coverage
✔ Clinically appropriate for TMS based on provider evaluation
Treatment can begin without submitting prior authorization.
Clinics can then bill Cigna for TMS services according to standard billing and documentation requirements.
This has the potential to significantly reduce time between evaluation and treatment start — particularly for patients who previously experienced delays due to authorization review timelines.
If your team is reviewing how to optimize intake and conversion workflows around faster treatment starts, this guide may help.
What This Does NOT Change
Even though prior authorization is being removed, several critical clinical and operational requirements remain:
Medical Necessity Still Matters
Documentation supporting diagnosis, treatment history, and clinical decision making remains essential.
Eligibility Verification Is Still Required
Coverage, network status, and plan-specific limitations must still be confirmed prior to treatment.
Claims Edits May Lag Policy Updates
Historically, when payers implement major policy changes, internal systems and claims logic can lag behind announcements. Clinics should monitor early claims closely after March 6 and escalate quickly if prior authorization–related denials occur.
If you want a deeper understanding of payer workflow risk points in TMS, you can read more here.
What Smart Clinics Are Doing Right Now
Clinics preparing for this change are already:
- Reviewing intake and eligibility verification workflows
- Aligning clinical documentation templates
- Preparing scheduling teams for potentially faster treatment starts
- Monitoring payer communications for additional clarification
Many clinics are also evaluating how marketing, intake, and clinical teams coordinate during rapid access scenarios.
What to Watch During the First 60–90 Days
During early rollout, clinics should pay close attention to:
- Early claim outcomes
- Denial reason codes tied to authorization logic
- Variations between plan types
- Differences between fully insured vs ASO / employer-sponsored plans
- Variability in information provided during VOB calls as payer reps may not yet be aware of updated policy changes
It is possible that some payer representatives may continue to reference prior authorization requirements during the transition period. Clinics should confirm eligibility, document VOB conversations carefully, and reference official policy updates if conflicting information is provided.
If prior authorization-related denials occur after March 6 for eligible scenarios, escalation through provider services may be required.
Why This Change Matters Beyond Operations
This move reflects a broader shift toward reducing administrative friction in behavioral health access. For TMS specifically, removing prior authorization can reduce drop-off between evaluation and treatment start — one of the most common barriers in patient access to care.
For patients who have often exhausted multiple medication trials before reaching TMS, faster access can be clinically meaningful.
If you want to learn more about how access barriers impact TMS adoption nationally, you can read more here.
Final Thoughts
Cigna removing prior authorization for TMS is a significant step forward for access, but successful implementation will depend on clinic readiness, workflow alignment, and early claims monitoring.
We recommend clinics treat the first 30–60 days as a learning period while payers finalize internal implementation across departments.
We’ll continue monitoring real-world claims behavior and payer communication as this rollout progresses.
