While TMS can be used to treat a variety of diseases outside depression, such as bipolar disorder, anxiety, ADHD, migraines, chronic pain, and others, most insurance coverage only cover it for individuals with moderate to severe Major Depressive Disorder (MDD). In addition to a diagnosis, you’ll need proof that you’ve taken at least two antidepressant drugs and found them to be ineffective. You’ll also need to establish that you’ve tried talking therapy to manage your depression but haven’t seen any progress as a result.
How much does insurance pay for TMS?
Our goal is to make the cost of TMS as low as feasible so that as many patients as possible can benefit from it. Depending on your plan’s copay or coinsurance amount, you’ll pay anywhere from $10 to $70 per session if you’re paying with insurance.
How much is TMS out of pocket?
Cost/Insurance TMS sessions typically cost $400-$500 per session, for a total cost of around $15,000, depending on the provider. ECT costs roughly $2,500 per session, or $25,000 for ten sessions, including a one-week hospital stay in some circumstances.
Is TMS covered by medical?
As the public’s understanding of TMS Therapy grows, so does insurance coverage. The majority of insurance companies cover TMS Therapy. Our TMS Coordinator will communicate with your insurance carrier to determine if TMS Therapy is a covered benefit under your policy. The following insurance companies* are in-network with us:
*Please keep in mind that TMS therapy is not a covered benefit under Medi-Cal.
Will insurance cover a second round of TMS?
Yes, in a nutshell, but there’s more to the story. In most cases, insurance companies will not pay for a service or procedure unless it is deemed medically necessary or suitable.
Can TMS damage your brain?
Many people mistake TMS for ECT, or electroconvulsive therapy. These two treatments, however, are significantly different.
TMS uses brief magnetic pulses to stimulate parts of the brain that are underactive in depressed persons. These magnetic pulses cause a flow of extremely small electrical charges that the patient cannot feel. These electrical charges stimulate neurons to fire, which reactivates the targeted area and improves mood.
ECT is normally performed when the patient is under general anesthesia in a hospital setting. The method includes administering regulated electrical currents to the brain, which causes a brief seizure. Despite the fact that electroconvulsive therapy (ECT) was developed in the 1930s, doctors are still unsure how it works to alleviate depressive symptoms. They do know, however, that ECT normally works rapidly and does not cause structural harm to the brain.
TMS treatments, on the other hand, can be done as an outpatient procedure. A coil is put on the outside of the patient’s head during TMS treatment to deliver tiny magnetic pulses. The process is painless and requires no anesthetic. It also has no effect on cognition or memory, and it doesn’t cause a seizure. The patient is free to talk, listen to music, or watch television during the session.
Why is TMS so expensive?
Repetitive Transcranial Magnetic Stimulation (rTMS or TMS) is a treatment for Major Depressive Disorder and Obsessive Compulsive Disorder that has been approved by the FDA (OCD). TMS Therapy uses a device that is worn on the patient’s head to stimulate areas of the brain that are underactive in those suffering from depression or OCD. TMS was a relatively expensive treatment when it first became available to the general public in 2008. Only one device (NeuroStar) was available for doctors to purchase, but it was extremely expensive. For a complete course of treatment, several doctors charged upwards of $16,000! There are a lot more possibilities for TMS these days.
TMS was once prohibitively expensive for a variety of reasons. First, the machine was so expensive that most doctors couldn’t afford to treat patients for less. Second, the first gadgets offered to the general public would cost between $60 and $100 each treatment for doctors. Before coming out ahead, the doctors would need to make at least $60100 per session, plus pay for a certified TMS technician and any related expenditures. Other devices, such as Brainsway’s “Deep TMS” machine and MagVenture’s “MagVita” machine, were subsequently approved by the FDA. Devices like the MagVita machine and the CloudTMS machine gave doctors the option of not having to pay for each session, which helped to lower treatment costs.
TMS is now much more inexpensive, and it is no longer prohibitively expensive. In 2013, major insurance companies like Aetna, Cigna, Blue Cross Blue Shield, Blue Shield of California (Magellan), Anthem Blue Cross, and Medicare began to cover TMS. TMS is considerably more inexpensive for individuals in need now that insurance companies cover it. Insurance coverage, on the other hand, differs from one insurance company to the next. Some insurance providers, for example, require that the patient has already tried at least four antidepressant medicines. Other insurance companies are far more accommodating.
The following are the major insurance companies’ requirements as of 2020:
- Aetna: in the past, 2 antidepressant drugs + 1 “augmentation” (timeframe of more than one medication taken concurrently)
- Cigna: two antidepressant drugs from two distinct classes (e.g., neither can be an SSRI).
It’s worth noting that each of these businesses also requires at least two months of prior counseling. Fill out our treatment history form to find out if your insurance will cover your TMS therapy. We will respond within 24 hours with information on whether or not your treatment will be covered.
The good news is that exceptions can be made. For example, we have a collaboration with more immersive programs like as TMS, ketamine, and group therapy. These bundled treatments are more likely to be approved together than separately by insurance.
We aspire to cut the cost of TMS even more as the leading provider of Express TMS in Southern California. Regardless of their financial condition, we think that everyone deserves the greatest mental health therapy. Please contact us immediately to schedule a consultation if you or a loved one are interested in learning more about the cost of TMS.
Can TMS make you worse?
TMS has been observed in certain trials to enhance anxiety when used for depression. Repetitive transcranial magnetic stimulation (rTMS) generated increased anxiety levels in those with panic disorder, according to a 2011 study.
TMS does not create anxiety, according to the Mayo Clinic, and it only causes associated illnesses like mania or seizures in exceedingly rare circumstances. Headaches, lightheadedness, and skin tingling are all temporary adverse effects of TMS, but they usually fade after a few sessions.
Speak to your doctor if you have increased anxiety after starting TMS treatments. Your doctor may be able to modify your sessions to lessen the negative effects.
What are the dangers of TMS therapy?
It’s a noninvasive treatment that stimulates nerve cells with electromagnetic pulses, which may help with symptoms of neurological and mental health conditions.
TMS is primarily utilized in the treatment of depression. It’s proven to be effective in treating people who don’t respond to antidepressants or psychotherapy. TMS was approved by the Food and Drug Administration (FDA) for this purpose in 2008.
TMS has also been shown to aid with other conditions such as anxiety and Parkinson’s disease.
TMS is also known as repeated transcranial magnetic stimulation because it involves repetitive electrical impulses (rTMS). The terms are frequently interchanged.
What type of doctor does TMS?
Privileges to prescribe Deep TMS vary per state in the United States, for example. While psychiatrists are the only doctors who may administer Deep TMS, several states allow other doctors, such as nurse practitioners, physician’s assistants, and prescribing clinical psychologists, to do so as well.
Similarly, various insurance carriers may establish a distinct list of healthcare practitioners who can do Deep TMS treatment (and be compensated for it). This means that healthcare practitioners interested in prescribing or providing Deep TMS therapy should check with their customers’ insurance companies to see if their plans support Deep TMS therapy and if they will be reimbursed for the treatments they offer.
Deep TMS is FDA-approved in the United States to treat Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD), and it is CE-marked in Europe to treat these and a variety of other mental health issues. Due to its expanding popularity, several insurance firms are eager to give Deep TMS to their clients. Since a result, those who are not insured for the treatment may contact their insurance company and inquire about Deep TMS coverage, as single-case agreements may be achievable in some situations.