Click here to access the standard Repetitive Transcranial Magnetic Stimulation Request Form (rTMS).

Note: F33.2 is the correct code for Major Depressive Disorder, Recurrent Episode, Severe (Without Psychotic Features). Currently, the code listed for this service on the standard form posted on the DOI website is incorrect.

Commercial Products

Providers can submit the completed form by:

Secure Email:     BHPriorAuthCommercial@tufts-health.com
Fax:                     617.673.0315
Mail:                    Tufts Health Plan
                            Behavioral Health Department
                            705 Mt. Auburn St.
                            Watertown, MA 02472
                            Attn: Psychiatric Reviewer

Tufts Health Public Plans Products

Providers can submit the completed form by:

Tufts Health Together and Tufts Health Direct
Fax:      888.977.0776
Mail:     101 Station Landing, 4th Floor
             Medford, MA 02155
             Attn: Behavioral Health Intake Team

Tufts Health Unify
Fax:      781.393.2607
Mail:      101 Station Landing, 4th Floor
              Medford, MA 02155
              Attn: Tufts Health Unify Intake Team