Authora
Notification of authorization determination
Issued May 31, 2026
Document #AUT-2026-00193
Lucia Franco, MD
Northgate Behavioral Health
NPI: 1456789012

Prior authorization approved

Re: AUT-2026-00193 · UHC · Okafor, Emeka

This letter confirms that the prior-authorization request submitted on behalf of Emeka Okafor (member ID UHC-220197553) for Transcranial Magnetic Stimulation — 36-session course has been approved.

The determination was rendered under Transcranial Magnetic Stimulation for Treatment-Resistant Depression (Optum Behavioral Health Medical Policy BH-005, effective 2026-01-01). All 5 medical-necessity criteria were evaluated against the submitted clinical evidence.

Clinical rationale: Treatment-resistant depression by FDA criteria; psychotherapy attempted; no contraindications; severity validated.

Authorization details

Authorization number
UHC-2026-119477
Effective
May 15, 2026
Expires
Sep 15, 2026
Service
Transcranial Magnetic Stimulation — 36-session course
CPT
90867, 90868
Determined by
L. Martinez, RN

Patient

Name
Okafor, Emeka
Date of birth
Jan 9, 1979
MRN
MRN-013002
Member ID
UHC-220197553
Plan
UnitedHealthcare Optum Behavioral

Diagnoses considered

CodeDisplay
F33.2Major depressive disorder, recurrent severe without psychotic features
L. Martinez, RN
um nurse