health service (nhs) in england, wales, scotland and northern ireland (uk). nice guidance does not cover whether or not the nhs should fund a procedure. local nhs bodies (primary care trusts and hospital trusts) make decisions about funding after considering the clinical effectiveness of the procedure and whether the procedure represents value for money for the nhs. nice evaluated tms for severe depression (ipg 242) in 2007, and subsequently considered tms for reassessment in january 2011 but did not change its evaluation. the institute found that tms is safe, but there is insufficient evidence for its efficacy. in january 2014, nice reported the results of an evaluation of tms for treating and preventing migraine (ipg 477). nice found that short-term tms is safe but there is insufficient evidence to evaluate safety for long-term and frequent uses. it found that evidence on the efficacy of tms for the treatment of migraine is limited in quantity, that evidence for the prevention of migraine is limited in both quality and quantity. subsequently, in 2015, nice approved the use of tms for the treatment of depression in the uk and ipg542 replaced ipg242. nice said "the evidence on repetitive transcranial magnetic stimulation for depression shows no major safety concerns. the evidence on its efficacy in the short-term is adequate, although the clinical response is variable. repetitive transcranial magnetic stimulation for depression may be used with normal arrangements for clinical governance and audit." united states: commercial health insurance in 2013, several commercial health insurance plans in the united states, including anthem, health net, and blue cross blue shield of nebraska and of rhode island, covered tms for the treatment of depression for the first time. in contrast, unitedhealthcare issued a medical policy for tms in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. unitedhealthcare noted that methodological concerns raised about the scientific evidence studying tms for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. other commercial insurance plans whose 2013 medical coverage policies stated that the role of tms in the treatment of depression and other disorders had not been clearly established or remained investigational included aetna, cigna and regence. united states: medicare policies for medicare coverage vary among local jurisdictions within the medicare system, and medicare coverage for tms has varied among jurisdictions and with time. for example: in early 2012 in new england, medicare covered tms for the first time in the united states. however, that jurisdiction later decided to end coverage after october, 2013. in august 2012, the jurisdiction covering arkansas, louisiana, mississippi, colorado, texas, oklahoma, and new mexico determined that there was insufficient evidence to cover the treatment, but the same jurisdiction subsequently determined that medicare would cover tms for the treatment of depression after december 2013. subsequently, some other medicare jurisdictions added medicare coverage for depression. providers manufacturers of tms devices include brainsway, deymed , magventure , mag&more , magstim, magnus medical , nexstim , neuronetics, neurosoft , rogue research inc. , sebers medical and actipulse neuroscience