A standard course of TMS treatment consists of 30 daily (M-F) treatments (6 weeks) followed by a taper period where the frequency of TMS treatments is gradually decreased. This taper usually consists of 6 sessions given over 2- 3 weeks. Sometimes a patient may have a very rapid full response and therefore does not require all 36 treatments, whereas other times improvement emerges more slowly than usual and additional treatment are required to get the full benefit.
While not all insurance companies cover TMS Therapy, several health insurance plans now offer coverage for TMS Therapy for depression, including:
- Most Blue Cross including Anthem
- Blue Shield
- Health Net
- United HealthCare
However insurance companies all require that a patient meet certain criteria to be eligible for coverage of TMS treatment. Typically these eligibility criteria include:
- A confirmed diagnosis of severe major depressive disorder (MDD) (Bipolar Disorder is not eligible at this time)
- At least 4 approved anti-depressant medication that were not effective or that were not tolerated because of side effects
- Tried an evidence-based psychotherapy without sufficient benefit
- Absence of the following
- Seizure disorder or any history of seizure (except those induced by ECT or isolated febrile seizures in infancy without subsequent treatment or recurrence); or
- Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, having a history of repetitive or severe head trauma, or with primary or secondary tumors in the central nervous system (CNS); or
- Presence of an implanted magnetic-sensitive medical device located less than or equal to 30 centimeters from the TMS magnetic coil (Note: Dental amalgam fillings are not affected by the magnetic field and are acceptable for use with TMS)
Furthermore, most insurance companies that cover TMS, require that the TMS provider submit an application for prior approval before treating a patient. This application includes information about the patients eligibility for TMS in context of the criteria listed above.
A patient who does not have insurance that covers TMS or does not meet their insurance company’s eligibility criteria, may still receive TMS therapy at UCSD by paying for the procedure.
* For more information about paying for TMS or getting your insurance to cover it contact at email@example.com