Will Your Insurance Cover TMS?

When prospective patients contact us about Transcranial Magnetic Stimulation (TMS), they often ask, “Is TMS therapy covered by insurance?” The good news is that most insurance companies now cover TMS treatment, as long as certain guidelines are met. 

What to Know about TMS and Insurance Coverage

The final approval of TMS insurance coverage will depend on your particular plan and the benefits it includes. However, there are some general criteria to keep in mind:

• You must be treated for an applicable mental health condition.

TMS is generally covered for major depression treatment. It also may be covered for use in treating obsessive compulsive disorder (OCD) and smoking cessation. Insurance does not cover TMS for treatment of other conditions such as post-traumatic stress disorder (PTSD) and bipolar disorder. 

• TMS should not be your first line of treatment. 

Insurance companies will want to see that you’ve tried some medications before approving TMS treatment. Sometimes, insurers will require that you’ve tried talk therapy. 

• Certain health conditions may disqualify you from coverage. 

Substance abuse, neurological conditions such as epilepsy, and medical devices such as cochlear implants are all potential obstacles to insurance approval.

Even if your insurance company approves TMS treatment, there will still be some costs depending on your deductible, copayments, and annual out-of-pocket maximum. Our patient counselors can help you determine what that cost will be.

What About Medicaid and Medicare?

Does Medicaid cover TMS therapy? Can Medicare benefits help defray treatment costs? Our patient counselors frequently hear these questions when people are inquiring about TMS. 

As with standard health plans, TMS coverage under Medicare and Medicaid is plan dependent. For instance, once you’ve met the deductible, Medicare may pay up to 80% of costs. We accept Medicare and Medicaid at certain locations; our patient consultants can help you find the most convenient location near you. 

You don’t have to worry about your TMS insurance coverage. We can help you get the TMS treatment you need and eliminate the guesswork involved in determining insurance benefits. Contact us today for a consultation.