Transcranial magnetic stimulation for treatment of selected conditions

Status: Comment period open

Policy context

Transcranial magnetic stimulation (TMS) is a noninvasive technique used to stimulate areas of the brain associated with mood regulation and delivers intense magnetic pulses into the brain. Certain studies and meta-analyses suggest that TMS may be an effective treatment for various conditions.

Primary criteria ranking

  • Safety = Low/Medium
  • Efficacy = Medium/High
  • Cost = Medium/High

Assessment timeline

  • Draft key questions published: July 8, 2022
  • Public comment period: July 8 to July 22, 2022
  • Final key questions published: August 23, 2022
  • Draft report published: January 5, 2023
  • Public comment period: January 5 to February 6, 2023
  • Final report published: TBD
  • HTCC public meeting: TBD


Mental health conditions affect a large proportion of the American population, according to several nationally representative surveys. Over 14 million adults (14.2%) are estimated to have serious mental illness (SMI), in which the mental illness causes serious functional impairment interfering with one or more major life activities. Individuals suffering these conditions often experience decreased quality of life and impaired function across physical, emotional, and social domains.

Current treatment approaches for behavioral health disorders often begin with psychotherapy, pharmacotherapy, or both. However, many people do not achieve adequate clinical responses after the initial treatment attempt, and second and third-line medications or procedures (e.g., electroconvulsive therapy (ECT)) carry risk of adverse side effects that many individuals do not tolerate. Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique that has been FDA approved for some behavioral health and neurologic conditions. There is a growing evidence base that TMS may be efficacious, with fewer or more tolerable side effects, and has led to growing interest in applying TMS to a broad set of conditions, most often those deemed treatment resistant.

This health technology assessment (HTA) reviews the efficacy, safety, and cost-effectiveness of TMS to assist the State of Washington's Health Technology Clinical Committee (HTCC) in determining coverage of TMS for the following selected behavioral health disorders: depression; anxiety disorders including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD);  posttraumatic stress disorder (PTSD); and addiction disorders including tobacco use disorder and substance use disorder (SUD).