TMS FAQs: Does Insurance Cover TMS Therapy?
Insurance documents and calls can be daunting and complicated. Coverage can be unclear, and policies difficult to read. It triggers hesitancies and anxiety when the only thing standing in the way of you and a new treatment to wellness is help.
Thankfully, much of this anxiety can be relieved with a little bit of information and preparedness. Suppose you are looking into Transcranial Magnetic Stimulation (TMS) therapy to treat your depression. In that case, these TMS FAQs will help you understand more about coverage requirements and whether this treatment is covered under Medicaid and Medicare.
Do most major insurance providers cover TMS Therapy?
The short answer is yes. If the treatment is considered medically appropriate, and criteria are met. Some insurance providers will have varying or additional requirements than others, but the below general criteria largely dictate coverage:
- You have previously attempted to treat your depression with antidepressant medications and that at least two or three of them have not been successful in gaining remission of symptoms. Yes remission is the goal.
- You have a history of either therapy, counseling, or psychotherapy.
- You have shown little to no improvement with therapy but made a reasonable attempt.
- You have been diagnosed with Major Depressive Disorder (MDD) or an illness linked to depression symptoms. These can include PTSD, Anxiety, and in some cases bipolar disorder.
What circumstances can disqualify me from coverage for TMS Therapy?
- If you have neurological conditions such as dementia or epilepsy.
- If you have a seizure disorder.
- If you are at acute risk for suicide.
- If you continually abuse substances, including alcohol, illicit, or prescription drugs.
- If you are pregnant or nursing.
- If you have any magnetic-sensitive medical devices or metal near or in your head, such as metal plates, permanent piercings, or cochlear implants. Dental fillings are NOT a disqualification.
Does Medicaid or Medicare cover TMS Therapy?
Yes, if all the requirements are met, Medicare may pay 80% of the cost while you would be responsible for your annual deductible, monthly premiums, and possibly the remaining 20% of the treatment cost can be paid by your secondary / supplemental insurance.
Coverage can vary based on your specific Medicaid or Medicare plan, but the basic criteria for Medicare coverage include:
- You have been diagnosed with Major Depressive Disorder (MDD) by a Medicare-approved physician.
- You have health reasons for which medication is not safe or recommended.
- You have a documented history of antidepressant medication use that was unsuccessful.
Is Medicaid coverage for TMS Therapy approved in the state of Montana?
The state of Montana has approved Medicaid for coverage of TMS Therapy, extending another life-changing treatment option for those who suffer from Major Depressive Disorder in our community. Our TMS team has seen transformative results for many who have not gained complete remission of symptoms despite multiple medications and psychotherapy.
Now, Medicaid patients can receive the same care as those with Medicare, Tricare, and private insurance unlocking a new treatment option for Medicaid patients that we have been championing for years!
TMS
by Deb (age 64)
Category: generalThe hoops I jumped through in order to be evaluated were straightforward and efficient. I met with PA Kaitlin for about an hour to discuss my history and previous medications. Then Dr. Amato joined us to further discuss my history, the TMS treatment, and answer any questions. Myrna gathered all of the information and submitted it to my health insurance company to request coverage for TMS. Fortunately, insurance approved the treatment and I was able to begin the next week. I’m sure most people have anxiety about starting a treatment like TMS. No matter how many times it’s described to you, there are many unknowns. How will I feel during treatment? Is it painful? What if this doesn’t work? What if it works for a while but then stops? In all honesty, I was very uncomfortable during the first couple of weeks of treatment. The alternating two seconds of tapping sensation caused some pain during treatment, and at the end of the first week I thought about quitting. But I had sworn to myself that TMS was a last resort and I HAD TO complete the treatment and give it a chance to work. My technician, Heather, told me that some people don’t feel the tapping at all, they only hear it. Guess I wasn’t one of those people! But as the days went by, it became easier to tolerate the treatments. During this time I also saw Lauren weekly for CBT (cognitive behavioral therapy). This is highly recommended for people undergoing TMS treatment, and it was a positive complement to my total of 100 minutes each week “under the helmet”. The weekend between weeks three and four, I started to notice subtle improvements in my mood, increased belief in my self-worth, and enthusiasm for simple things like going for walks, meeting friends for lunch, and taking on volunteer work in the community. I hesitated at first to believe that TMS was helping me. I was afraid that I was convincing myself it was working because I so desperately wanted it to! But now that I am past the treatment I can say with cert
TMS
by Barbie (age 68)
Category: generalI feel so blessed to participate in the TMS protocol at MT Psychiatry. After struggling so many years with depression and not getting significant results from medication, particularly of late, I noticed positive results in the first two weeks of treatment. TMS can literally give you back the beauty & joy in living as well as the courage to make positive life changes and improvements in your daily living situation. I heartily encourage anyone to put yourself into the hands of the amazing TMS team who so gently and graciously make this journey with you out of the black hole that is depression. It is my honor and privilege to give the TMS treatment the highest recommendation.
TMS
by Shayne (age 66)
Category: generalI am grateful for the support and caring I have received from Dr. Amato (and Heidi, Heather and Myrna) in my quest for mental health and a fuller more productive life. While the TMS results have been subtle, I feel more positive about my future and I would recommend this team absolutely. Thank you!
TMS
by Carrie (age 65)
Category: generalNot realizing how fuzzy my head was, I thought I was only going through severe anxiety and depression. Through the insight of Pat, I was able to go through TMS treatments which brought down the anxiety and depression immensely and has cleared up the fuzzy, far off substantially. All the personnel treated me with kindness and I’m sure their attitudes helped in my recovery.
TMS
by Bridget (age 47)
Category: generalThe first outcome of TMS I noted happened early in my treatment, at about the beginning of week two. I felt as though my “brain fog” had been chipped away. I wish I could report that I feel my mental health issues are in “remission”, but I can’t do so yet. My hope is that I will see improvement in the weeks to come, now that my TMS cycle has ended. I can say that my brain feels – in some way – different; I can’t explain exactly how. I continue to struggle at this point in time but sill have hope for more improvement.
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