Is TMS Covered By Insurance?
Most insurance companies will only cover medically necessary services or procedures. Transcranial Magnetic Stimulation (TMS) therapy is now considered medically necessary for the treatment of depression and is therefore covered by many policies. However, there may be some limits to coverage that can vary among insurance providers, so it’s important to check with your benefits administrator before scheduling TMS sessions.
Requirements for TMS coverage
While TMS can be used to treat conditions other than depression—including bipolar disorder, anxiety, ADHD, obsessive compulsive disorder, migraines, chronic pain, and others—some insurance companies may only cover TMS for patients who have moderate to severe Major Depressive Disorder (MDD) as diagnosed by a psychiatrist. Patients must also have tried at least two medications for depression that have not been helpful and attempted to treat their depression with talk therapy without success. If you believe you meet these criteria, check with your insurance company to see if TMS will be covered under your policy.
TMS therapy cost with insurance coverage
If you’re paying with insurance, you’ll pay anywhere between $10 and $70 per session, depending on your plan’s copay or coinsurance rate. A total of 36 sessions, plus one brain mapping session, are required to complete the treatment course.
TMS Therapy Cost Without Insurance Coverage
TMS therapy is a viable option for some people, but it may be cost-prohibitive for others. Though many health care providers such as anew era offer a free consultation, sessions of TMS typically cost between $400 and $500 and can vary depending on your provider. Given that most people need a series of TMS therapy sessions to see proper results, the total cost of TMS therapy could be around $15,000.
At this time, not all insurance companies cover the cost of TMS therapy. Coverage may depend on your specific insurance plan. Some companies have restrictions on who is covered for TMS treatment. For example, Blue Cross Blue Shield offers coverage for TMS treatment, but only for adult patients who have not found success with therapy or antidepressants. Therefore, before proceeding with TMS treatment, check with your mental health professional and insurance plan to see if you are covered. Hopefully, coverage options will increase in the future as TMS therapy becomes more popular. This would lower the cost for millions of people.
If you meet the requirements for TMS therapy, most major insurance companies will cover the cost of TMS Therapy, including but not limited to:
CALIFORNIA TMS HEALTH INSURANCE COVERAGE
- Aetna
- Blue Shield of California
- Cigna
- Anthem Blue Cross
- Magellan
- Tri-Care
- United Health Care
- Chipa
- Optum
- Health Net
UNITED STATES TMS HEALTH INSURANCE COVERAGE
- Anthem Blue Cross and Blue Shield
- Arkansas Blue Cross Blue Shield
- Blue Cross Blue Shield of Alabama
- Blue Cross Blue Shield of Arizona
- Blue Cross Blue Shield of Florida
- Blue Cross Blue Shield of Hawaii (HMSA – Hawaii Medical Services Association)
- Blue Cross Blue Shield of Kansas
- Blue Cross Blue Shield of Louisiana
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan
- Blue Cross Blue Shield of Minnesota
- Blue Cross Blue Shield of Nebraska
- Blue Cross Blue Shield of North Carolina
- Blue Cross Blue Shield of Rhode Island
- Blue Cross Blue Shield of Tennessee
- Blue Cross Blue Shield of Vermont
- Blue Cross Blue Shield of Western New York (Under Health Now)
- Blue Cross Blue Shield Federal Employee Program
- Blue Cross of Idaho
- Blue Shield of California
- Blue Shield of Northeastern New York (Under Health Now)
- Capital Blue Cross
- Cigna
- Community Care of Oklahoma
- Emblem Health
- Harvard Pilgrim
- Health Care Service Corporation (HCSC) for BCBS of Illinois, Montana, New Mexico, Oklahoma, and Texas
- Health Net
- Health New England
- Horizon Blue Cross Blue Shield of New Jersey
- Independence Blue Cross
- Independent Health Association
- MVP Healthcare
- Optima Behavioral Health
- Oxford Health Plans
- Premera Blue Cross
- Priority Health
- Public Employees Insurance Agency (PEIA)
- The Regence Group
- Tri-Care
- Tufts Health Plan
- United Healthcare/OPTUM by United Behavioral Health
MEDICARE PLANS
(Please Note: Most states have the same LCD#, but are listed separately by state.)
- Cahaba Government Benefit Administrators, LLC
- CGS Administrators, LLC
- First Coast Service Options, Inc.
- NGS (National Government Services, Inc.)
- Noridian Healthcare Solutions, LLC
- Novitas Solutions, Inc.
- Palmetto GBA
- WPS (Wisconsin Physicians Service Insurance Corporation)
MEDICAID PLANS
- Medicaid of Vermont
- Aetna
- Anthem
- Blue Cross Blue Shield
- Cigna
- Humana
- Kaiser
- Tricare
- United Healthcare
Additionally, Medicare and Medicaid also cover TMS therapy if the same requirements are met. However, coverage might only amount to a certain percentage of the cost (usually 80%).
How to improve your chances of TMS coverage
If you have a short-term medical condition that would make TMS treatment ineligible for insurance coverage, such as pregnancy, you can wait to begin treatment until later. However, you’ll need to be able to show evidence that you’ve attempted other treatment options first. To improve your chances of insurance policy coverage for TMS, it’s important to keep accurate treatment records and be honest about your progress or lack thereof with your doctors. It is important to follow through with each treatment as prescribed, including taking all medication and attending all therapy appointments. Your insurance may not cover TMS if there is evidence that you missed doses or appointments.
How Can I Get TMS Therapy Covered By Insurance?
If you want your insurance to cover TMS therapy, it helps to have a letter from your doctor stating that you have major depressive disorder (MDD). It also helps if your medical records show that you’ve received other forms of treatment for MDD, like psychotherapy, antidepressants, electroconvulsive therapy (ECT), or a combination of ECT and antidepressants. And finally, it’s helpful if your medical history shows no previous head injuries.
Potential disqualifications for TMS coverage
Some insurance companies might have more restrictive requirements to cover TMS, and some policies might disqualify you for coverage based on certain complicating factors, such as:
- Pregnancy or nursing
- Acute risk of suicide
- Ongoing substance abuse
- Diagnosed neurological conditions (epilepsy, seizure disorders, dementia)
- Presence of magnetic-sensitive medical devices or objects (cochlear implants, stents, bullet fragments)
But if you are suffering from depression, and you’re in need of relief, don’t just assume you don’t qualify for TMS coverage with your insurance policy. Speak with a mental health professional about your condition and the treatments you’ve tried in the past. They may be able to provide you with information that increases your chances of coverage so you can get the treatment you need.
What to do if TMS therapy Coverage is Denied
If your insurance company denies coverage for TMS, there are various medical financing programs available to make the treatment accessible. Some providers even offer sliding-scale pay options based on income levels. This means that regardless of your financial situation, you may still be able to receive TMS treatment.
If you or someone you love has been diagnosed with MDD and traditional medications, treatment options, and therapies have not been effective, TMS therapy is FDA approved may be a good option to consider. At Anew Era TMS, we offer this therapy along with other mental health treatments, and our team is committed to helping improve our patients’ quality of life and mental health. To learn more about TMS therapy or to schedule a consultation, please fill out our contact form or check your insurance with us online.
