AN ACT to provide fair reimbursement of transcranial magnetic stimulation services under health benefit plans offered in this state.

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑254.  Coverage of transcranial magnetic stimulation.

(a)        The following definitions apply in this section:

(1)        Reserved for future codification purposes.

(2)        Insurer. – As defined in G.S. 58‑3‑167.

(3)        Reserved for future codification purposes.

(4)        Transcranial magnetic stimulation. – A noninvasive healthcare treatment that uses pulsed magnetic fields to induce an electric current in a localized region of a patient's brain.

(b)        Insurers offering a health benefit plan in this State that provides coverage for transcranial magnetic stimulation shall provide coverage for all transcranial magnetic stimulation procedures performed by a healthcare facility or properly licensed healthcare provider for whom ordering, performing, and supervising the treatment of depression and other mental disorders is within their scope of practice in accordance with Chapter 90 of the General Statutes and may not penalize any properly licensed healthcare provider or healthcare facility that properly submits a claim for services related to transcranial magnetic stimulation based on the medical specialty of the healthcare provider or healthcare facility submitting the claim.

(c)        Notwithstanding subsection (b) of this section, it shall be within the discretion of each insurer offering a health benefit plan in the State that provides coverage for transcranial magnetic stimulation to determine all of the following aspects of the coverage:

(1)        Whether to cover transcranial magnetic stimulation procedures.

(2)        Indications for which transcranial magnetic stimulation procedures shall be covered.

(3)        Requirements for coverage for transcranial magnetic stimulation procedures.

(4)        Reimbursement rates for transcranial magnetic stimulation procedures.

(d)       Penalties prohibited under this section include the denial of, or the reduction of, or the placement of limitations on the reimbursement of a properly submitted claim, or any other negative treatment of a properly submitted claim.

(e)        Reimbursement rates that differ based upon any of the following are allowable and shall not be considered a penalty prohibited under this section:

(1)        A healthcare provider's participation or lack of participation in the network of an insurer.

(2)        The location where the transcranial magnetic stimulation services are provided.

(3)        The level of training, certification, or education of the healthcare provider, within that provider's medical specialty, that has provided the transcranial magnetic stimulation services.

SECTION 1.(b)  G.S. 135‑48.51 is amended by adding a new subdivision to read:

(8a)    G.S. 58‑3‑254, Coverage of transcranial magnetic stimulation. It is within the discretion of the Plan to determine all aspects of the coverage of transcranial magnetic stimulation identified under G.S. 58‑3‑254(b).

SECTION 2.  This act is effective October 1, 2025, and applies to insurance contracts issued, renewed, or amended on or after that date.