Cigna and Evernorth Drop TMS Prior Authorization Requirements; Here's What That Actually Means for Your Practice

Tl;dr: Starting March 6, 2026, TMS prior authorization will no longer be required for Cigna/Evernorth in-network providers. Osmind's CMO breaks down why that doesn't mean fewer denials—and what practices should do differently.

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Starting March 6, 2026, Cigna Healthcare and Evernorth will no longer require prior authorization for transcranial magnetic stimulation (TMS) for in-network contracted providers. On the surface, this sounds like a win: fewer hoops, faster access to treatment. And in many ways, it is.

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But before you celebrate, there's a critical distinction every TMS practice needs to understand: no prior auth does not mean no denial.

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A Brief History of Cigna and TMS Worth Knowing

If you've been in the TMS space for a while, you know that Cigna's relationship with this treatment has been complicated. TMS received FDA clearance in 2008, yet Cigna continued to classify it as "experimental" for years afterward — well into 2016 and 2017 by most accounts. Practices that believed in the treatment and wanted to offer it to patients faced an uphill battle getting reimbursed.

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That history matters here. Cigna eventually came around on coverage, and now they're reducing the administrative burden of prior authorization. That's genuine progress. But given how this payer has approached TMS over the years, it's worth reading the fine print carefully.

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TMS Prior Auth Changes in 2026

Evernorth announced that effective March 6, 2026, contracted (in-network) providers will no longer need prior authorization before delivering TMS to patients covered under Evernorth and Cigna Healthcare plans. This applies to dates of service on or after March 6 — any TMS delivered before that date may still require prior authorization.

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Important caveats:

• This only applies to in-network/contracted providers. Out-of-network providers must continue to obtain prior authorization for TMS.
• Patients with Cigna Connect Individual & Family Plans (IFP) may have out-of-network considerations for services outside their state of residence. Always verify benefits and eligibility — you can identify these patients by checking their Cigna Healthcare ID card for the plan name.
• Network exception requests will still require prior authorization.

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Why This Matters (and Why It's Not a Free Pass)

We spoke with Osmind's Chief Medical Officer, Dr. William Sauvé, about what this change means in practice.

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"It's nice to not have to submit a PA," said Dr. Sauvé. "But the same eligibility and medical necessity rules still apply. All the lack of prior auth means is that it will be 100% on the clinic to know and follow those criteria and document accordingly, or Cigna will simply deny treatments after the fact, leaving everyone on the hook."

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Here's the scenario every practice should think through:

Before this change, the workflow was straightforward — submit a prior auth, get a yes or no, and proceed accordingly. A denial before treatment is disappointing, but manageable.

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After this change, the risk shifts. Without prior authorization as a checkpoint, a practice could deliver a full course of TMS treatment only to have Cigna deny the claim retroactively for not meeting medical necessity criteria. In that scenario, the patient could be on the hook for $10,000 or more — and the practice may have no recourse.

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"Think about the difference," Dr. Sauvé explained. "With prior auth, you get told 'no' before treatment happens. Without it, you do the treatment, then get denied. The patient is stuck with the bill."

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This isn't just Osmind's read on the situation; it's the consensus across the industry. The eligibility and medical necessity rules haven't changed. The only thing that's changed is who's responsible for verifying them upfront.

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For all TMS practices, here's what we recommend:

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For practices partnering with Osmind—whether through Osmind 360 or Osmind Care Network — our RCM team will continue to verify benefits and confirm medical necessity criteria are met before treatment begins, regardless of whether prior authorization is technically required. This is exactly the kind of nuance that specialized billing expertise catches.

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1. Keep verifying benefits and eligibility before every course of treatment. The prior auth requirement is gone, but that doesn't mean you should skip due diligence. If anything, it's more important now — because the safety net of a pre-treatment decision is gone. Call Provider Services at 800.926.2273 or use the Evernorth Provider portal to confirm coverage details.

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2. Know Cigna's medical necessity criteria inside and out. This is no longer Cigna's job to check before you treat. It's yours. Make sure your clinical team understands exactly what documentation and clinical criteria Cigna requires for TMS coverage, and that every patient's chart reflects it.

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3. Continue documenting to the same standards. Your documentation needs to demonstrate medical necessity for every patient — the same as if prior auth were still required. The bar hasn't moved; the checkpoint has.

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4. Know which patients this applies to. This change is specific to Cigna and Evernorth plans with in-network providers. Your patients on other payers still have their existing prior auth requirements.

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5. Watch for retroactive denials closely. Without the prior auth safety net, claims denials may surface weeks or months after treatment. Make sure your billing workflow includes robust denial tracking and follow-up.

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What About Practices Outside the Cigna/Evernorth Network?

If you're not contracted with Cigna or Evernorth, this change doesn't affect your workflow; prior authorization is still required for out-of-network TMS claims.

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That said, this announcement could signal a broader industry trend. Payers have been under increasing pressure to reduce prior authorization burden, and TMS prior auth has long been one of the most time-consuming processes in interventional psychiatry. We'll be watching closely to see if other payers follow suit — and whether the same "no PA, same medical necessity rules" pattern holds.

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In the meantime, the best thing any practice can do is work with a billing team that understands the nuances of interventional psychiatry. Whether Cigna requires prior auth or not, the compliance and documentation standards remain the same. The practices that stay disciplined about verifying coverage and documenting medical necessity—regardless of what's technically required—are the ones that won't get caught off guard.

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Osmind is the leading practice partner for interventional psychiatry. Our psychiatry-tailored platform and specialized billing services help practices navigate complex payer requirements so you can focus on patient care. Schedule a consultation to learn how we can help your practice.