Insurance

BrainsWay’s Deep TMS treatment for MDD is covered by most insurance companies and HMOs in the United States.  OCD coverage may currently be available on a single case agreement basis.

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Deep TMS Coverage Basics

On the strength of FDA-clearance, peer-reviewed clinical evidence, and real-life clinical success, many public and private insurance carriers now offer coverage for Deep TMS.

Coverage differs by country, state, and insurance plan – if you are considering treatment, please speak to your healthcare provider and/or insurance carrier for additional information on coverage.

In the US, which is characterized by public payors, such as Medicare, Medicaid, and Tricare, and private payors, such as Aetna, Cigna, and United Healthcare, prior authorization is typically required to authorize TMS treatment.  Healthcare providers offering Deep TMS should become credentialed with the insurance carrier.  Out-of-network providers, or those seeking patient coverage for non-covered TMS treatment, can seek single case agreements.

In Canada, which is characterized by a universal public healthcare system administered by provincial health ministries and supplementary private policies, insurance coverage differs among provinces.

Beyond North America, BrainsWay Deep TMS treatment is covered throughout Europe, Asia, and other regions, as an increasing number of insurance providers are looking to meet their clients’ needs by offering coverage for this groundbreaking treatment.

Patient costs for TMS treatment can involve copays per session or co-insurance, taking into account deductibles and out-of-pocket maximums.

Insurance carriers’ medical policies and criteria for authorizing Deep TMS treatment vary, but will generally include several requirements, including primary diagnosis of Major Depressive Disorder and sufficient antidepressant and psychotherapy trials which had insufficient outcomes or intolerable side effects document in recognized ratings scales.  As the number and duration of trials required differ, we encourage you to consult directly with insurers or reach out to BrainsWay’s reimbursement support team for assistance.

3 Distinct CPT Codes have been created by the AMA for TMS treatment:

  • 90867 – initial TMS session that includes motor threshold determination, mapping, and the first treatment session.
  • 90868 – individual subsequent treatment sessions
  • 90869 – any subsequent session that includes a motor threshold redetermination

Additional information on coding can be found in the resources below.

BrainsWay’s Reimbursement Center

BrainsWay offers reimbursement support services for your practice as it seeks to provide optimal care to your MDD & OCD patients who are eligible for TMS treatment.

BrainsWay established “Reimbursement on Demand” as a means of providing guidance and support to our partners in navigating the sometimes complex reimbursement process in different states with different payers. We have reimbursement experts on staff who can provide hands-on assistance to help ensure the success of our clinical partners.

Services include:

  • Benefits verification
  • Medical exception support services
  • Guidance with prior authorizations (PA) and follow up
  • Guidance with pre-determinations (Pre-D) and follow up
  • Assistance with claim submissions
  • Appeals support

Contact our reimbursement support team at:
  • Phone:  844-333-7867 (844 DEEP TMS)
  • Fax:  844-332-3897
  • Email:  info@BrainsWayReimb.com

*NOTE : BrainsWay provides its reimbursement support, service and any related information for your convenience only. These services and all related information are not recommendations regarding clinical practice, and are generalized in nature. This generalized guidance is meant to guide – not replace – the reimbursement and billing staff of the doctor/clinic. BrainsWay does not make any representations or warranties regarding payment, and there are no guarantees of payment by any payer. It is the absolute and sole responsibility of the provider to ensure that a medical necessity determination is reached, and that appropriate claims and charges for services rendered are submitted. In the event that a favorable coverage determination is not achieved, BrainsWay is not and shall not be liable for any cost whatsoever, including those related to the patient’s medical treatment.


 

Download Reimbursement Resources