Is TMS Covered by Health Insurance?

TMS therapy is covered by Medicare and most commercial insurance companies. Many insurance companies pay for TMS therapy for depression because it’s effective and FDA-approved for the treatment of major depressive disorder.

While most insurance companies cover TMS therapy, they will only do so if TMS treatment is determined to be “medically necessary” according to the specific guidelines of your plan.  Guidelines vary slightly from company to company and from plan to plan, but tend to have some of the following things in common: 

• A diagnosis of depression
• Attempts at resolving depression with antidepressant medications with no significant lasting improvement
• A history of therapy or counseling carried out by licensed professionals
• No history of seizures or seizure disorder

Insurance Eligibility for Conditions Other than Depression

Although the FDA approved TMS for treatment of Obsessive-Compulsive Disorder (OCD) in 2018, many insurance companies still do not cover it yet. Furthermore, even though PTSD, Bipolar Depression, and anxiety also can benefit from TMS, the FDA has yet to approve its use for these disorders. Consequently, insurance companies often will not cover TMS treatment for them.

How Can I Find Out if My Insurance Plan Will Cover TMS for Me?

For us to determine if you can benefit from TMS and if your insurance company would cover your treatment, we would have to do a thorough evaluation of your personal history and insurance benefits.  Sometimes we can do this through a records request from your current physician or therapist, although many times one of our licensed mental health providers would have to formally evaluate you through a telehealth or in office visit.  If you would like us to explore your eligibility further, please click the below link and provide us with some basic information about your prior treatment, and someone from our office will get back to you to answer your questions and explain the process further.

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