Is TMS Covered By Insurance?
Insurance Coverage for TMS Therapy: An Overview
Health insurance coverage is an important aspect when considering TMS Therapy and Deep TMS Therapy for mental health disorders like depression, anxiety, and OCD. Today, most health insurance plans cover for TMS treatments for people when certain conditions are met.
In this comprehensive guide, Kadima’s insurance specialist will explore the requirements of insurance coverage, offer tips for maximizing your chances of approval, review the costs involved and answer your burning question: Is TMS covered by insurance?
Dr. David Feifel, a TMS Therapy Expert and Kadima’s Founder and Medical Director, sitting next under Kadimas Deep TMS Device
Whether you’re a patient seeking effective treatment or a healthcare provider seeking to expand your knowledge, this article provides valuable insights into the ins and outs of TMS insurance coverage in California.
In general, insurance coverage for TMS therapy varies depending on the specific condition being treated, the severity of the condition, the TMS provider, and the insurance provider. The good news is that TMS therapy has gained recognition as an effective treatment for MDD and TRD, leading to increased coverage by many insurance plans.
Requirements for TMS coverage
The requirements for insurance coverage for TMS therapy varies between different health insurance, here are the common requirements:
– A DSM-5 diagnosis of Major Depressive Disorder (MDD) or Obsessive Compulsive Disorder (OCD)
– Documentation of adequate trials of antidepressants medications that failed.
– Some insurances may request different medication classes (i.e SSRI, SNRI, MAOI’s, etc.)
– Trial of psychotherapy with credentialed psychotherapist (Psychologist, LMFT, LCSW, etc.)
– Being over 18 years old
Does Insurance Cover TMS for Depression?
Good news! Most health insurance plans cover TMS Therapy for depression, but some conditions must be met first. Each plan has its own requirements, some of the most common ones are described above. We suggest to call your health insurance provider and verify that you are qualified.
TMS Therapy Cost With Insurance Coverage
TMS therapy costs with insurance vary based on your plan and provider. Many insurance plans cover the majority of the cost, leaving you with minimal out-of-pocket expenses.
TMS Therapy Cost Without Insurance Coverage
Without insurance coverage, TMS therapy costs range from $7,000 to $10,000 for a typical treatment course. This includes 30-36 sessions averaging $200-$300 each. However, some clinics offer payment plans and financial assistance programs.
What Insurances Covers TMS Therapy?
Here are the major insurance companies that cover TMS therapy for depression:
- Magellan Health
- Optum
- Health Net
- MHN Health
- Tricare
- United Healtcare
- Aetna
- BlueCross
- BlueShield
- Medicare
- Cigna
Seeing your health insurance company name listed doesn’t guarantee TMS coverage. Plans vary in terms of coverage and requirements. Call your provider to confirm your eligibility.
How to improve your chances of TMS coverage
Potential disqualifications for TMS coverage
As mentioned, each insurance plan has unique coverage criteria. Here are some common disqualifying factors for TMS coverage:
- Being under 18
- Seizure disorder
- History of Psychosis
- Schizophrenia
- Substance abuse
- Pacemaker or implanted metal devices
What to do if TMS therapy Coverage is Denied
Depending on the denial reason, the TMS provider may be able to overturn the decision with a doctor’s opinion. If you lack required medication trials, you may need to try another antidepressant before seeking approval again.
Main Criteria For Insurance coverage
Diagnosis of MDD or OCD
DSM-5 Diagnosis of Major Depressive Disorder (MDD) or Obsessive Compulsive Disorder (OCD) given by a licensed professional
Failed Antidepressant Medications
Failure of 2-4 adequate trials of antidepressant medications
Psychotherapy with Licensed Professional
Trial of psychotherapy with credentialed psychotherapist(Psychologist, LMFT, LCSW, etc.)
Future of TMS coverage
A significant development in 2023 is the expansion of coverage for second-round TMS treatments by some insurance plans. This positive change offers renewed hope for patients who require additional sessions to achieve optimal results. Some insurances now cover for advanced type of TMS therapy called Deep TMS.
As the body of evidence for TMS therapy’s effectiveness continues to solidify, its accessibility through insurance coverage is steadily expanding. This positive trend reflects the growing recognition of TMS as a valuable treatment option for individuals struggling with depression, particularly for those who haven’t found relief through traditional methods.
Get in Contact
Our doctors will assess your conditions and see if you qualify for TMS therapy. Call us for a doctor assessment
(858)412-4130
Address: 3252 Holiday Ct Ste 112, La Jolla, CA 92037
Leave your details and we will contact you:
