Transcranial Magnetic Stimulation (TMS) is an FDA-approved treatment for severe cases of Major Depressive Disorder (MDD) that targets the brain with magnetic pulses.
It is thought to stimulate regions associated with mood, impulse control, and emotional regulation, strengthening neural pathways and regulating nerve cell activity. Off-label, it’s used for the treatment of anxiety, substance use, mood disorders, and sometimes chronic pain.
TMS can be expensive, costing upwards of thousands of dollars for a course of treatment, but the good news is that insurance usually covers TMS. Exact coverage depends on the type of TMS you are receiving, the condition it’s being used to treat, and whether the treatment facility is in-network and accepts insurance.
Read on to learn more about your options and how Harper Clinic Utah can offer you affordable, insurance-covered TMS therapy.
What Types of TMS Are Covered by Insurance?
Most insurance providers cover conventional TMS treatment for Depression and certain other mental health conditions, although some specialized forms or newer forms of TMS may not be covered. Below are each type of TMS and the coverage level they offer [1]:
- Repetitive TMS (rTMS): This is the most widely covered form of TMS, ranging from $300 to $500 per session without insurance, and $50 to $250 with insurance. It delivers repeated, small magnetic pulses to the brain, usually in the prefrontal cortex, to help regulate mood.
- Deep TMS: Often covered for major depressive disorder and treatment-resistant OCD, with similar costs to rTMS. It uses specialized coils (H-coils) to stimulate deeper and broader areas of the brain than rTMS.
- Intermittent Theta Burst Simulation (iTBS): Accelerated version of standard TBS, not yet covered by insurance, and can cost upwards of $6,000 to $20,000 for a treatment course. This method delivers bursts of high-frequency stimulation in a shorter session, offering comparable results to rTMS with less treatment time.
- SAINT™TMS: Not yet covered in outpatient settings, but the Center for Medicare and Medicaid Services (CMS) reimburses for SAINT in hospital settings. Costs typically are $30,000 to $36,000 for a one-week program. This method delivers 10 treatment sessions per day for five consecutive days, significantly speeding up the therapeutic effects.
TMS Coverage and Cost Comparison
| TMS Type | Efficacy | Session Schedule | Cost Without Insurance | Cost With Insurance |
| rTMS | 50% responsiveness, 30% remission | 20-30 sessions, over 4-6 weeks | $6,000 to $15,000 | Around $1,000 to $7,000 |
| Deep TMS | Similar to rTMS | Similar to rTMS | $6,000 to $15,000 | Same as rTMS |
| iTBS | Similar to rTMS | Similar to rTMS, although accelerated options exist | $6,000 to $20,000 | Not widely covered |
| SAINT™ | 85% responsiveness, 70% remission | 50 sessions over 5 days | $30,000 to $36,000 | Some coverage in hospital settings, but not covered in outpatient settings. |
What Are The Eligibility Criteria for Insurance?
TMS usually requires pre-authorization, meaning insurers need to approve coverage before treatment can begin. If your provider covers TMS, they typically require you to meet certain criteria to receive treatment. These include [2]:
- Diagnosis of MDD or treatment-resistant depression
- Failed antidepressant treatment (having already tried 2+ medications)
- Some insurance providers require documentation of previous psychotherapy already tried
- Some insurance providers may only approve coverage for severe cases where symptoms interfere with daily functioning
- Proof of medical documentation, such as a letter from your psychiatrist or therapist
- Typically covered for ages 18 to 65, off-label use outside of this age range is rarely covered
What Can Disqualify Me From Receiving Coverage?
There are several factors that may disqualify you as a candidate for TMS or be reasons for denial. Each provider sets its own rules, but some of the most common reasons for denial include [2]:
- Age: Under 18 or over 65
- History of Seizures: Epilepsy or traumatic brain injury (TBI)
- Psychotic Vulnerabilities: History of psychosis or schizophrenia
- Implanted Medical Devices: Metal devices near the brain or pacemakers
- Pregnancy: Many insurance providers require postponing treatment
- Acute Suicide Risk: TMS may only be offered in a hospital setting where crisis care is offered
We strongly recommend speaking with your current insurance provider to understand your coverage. Some key questions to ask include:
- Does my insurance plan cover TMS therapy?
- If not, is there a way to change my current plan or add on a supplemental piece?
- What conditions are covered by my plan for TMS?
- How many sessions are covered?
- What are my out-of-pocket costs?
- Do I need to meet certain criteria or obtain pre-authorization?
When covered by TMS, it’s common for a TMS treatment visit to be comparable to a standard mental health session (around $40 to $60). However, this depends highly on your specific plan and deductible.
What To Do If Your Insurance Coverage is Denied for TMS?
If your insurance provider denies your coverage for TMS treatment, don’t lose hope. You still have options and can often appeal the decision. If you’re denied for coverage, a few options include:
- Appeal the Decision: Work with your mental health therapist and TMS technicians to provide additional documentation and request a review.
- Explore Financing Options: Many clinics offer payment plans or third-party financing to help make treatment affordable and accessible.
How Do I Maximize My Chances of Getting Coverage?
Before submitting your request for TMS therapy insurance coverage, make sure you have proper documentation in place to improve your chances of approval. Some things to do to maximize your chances of getting covered include:
- Provide detailed documentation of medications, psychotherapies, and hospitalizations.
- Get a recommendation letter from your doctor to explain why TMS is medically necessary and why it’s being recommended as a treatment.
- Understand your insurance policy, review coverage, terms of your policy, and make sure you meet your provider’s criteria for coverage.
- Keep copies of everything, including communication between you and your insurance provider, and follow up frequently as approvals can take time.
FDA-Approved TMS Therapy for Depression Covered By Insurance
Harper Clinic Utah offers advanced, evidence-based TMS therapy in Utah for those battling treatment-resistant depression. If you’ve tried multiple treatments without success, our consultation team can assess your eligibility and guide you toward renewed hope. Contact us today to verify insurance and start your TMS treatment journey.
If you have already tried 2+ conventional treatments for depression, such as antidepressants and CBT, and have not found relief, you may be a good candidate.
Speak with a clinician to review candidacy, verify your insurance coverage, and schedule your TMS mapping session today. Contact our consultation team!
Sources
[1] Nunez, K. 2021. TMS Therapy. Healthline.
[2] Bermudes, R. 2021. Guidance on Navigating Insurance Plans for TMS-Eligible Patients. Psychiatry Online.