In the U.S., BrainsWay’s Deep TMS treatment is covered by Medicare and nearly all major private insurers to treat major depressive disorder (MDD) and anxious depression. Many insurers also cover Deep TMS treatment for obsessive-compulsive disorder (OCD). Currently, smoking addiction treatment is not covered.
Outside of the U.S., the cost to patients for Deep TMS treatment is variable, depending on the specific country and health coverage structure. Speak to your mental health provider or health insurer to better understand the costs that you would incur.
In order to be eligible for Deep TMS treatment, a person battling a mental health condition must meet the requirements defined by their insurance provider, which are informed by the specific FDA clearances for Deep TMS.
Appropriate diagnosis with sufficient severity
Insufficient benefit from a trial of psychotherapy
Insufficient improvement with trial(s) of medication or inability to tolerate side effects
No contraindications for Deep TMS
Prior authorization is typically required to initiate Deep 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.
Patient costs for TMS treatment can involve copays per session or co-insurance, taking into account deductibles and out-of-pocket maximums.
Contact your insurance provider to learn about eligibility for Deep TMS treatment under your specific plan.
Three Distinct CPT® Codes have been created by the AMA for TMS treatment:
90867 – TMS Initial Motor Threshold (MT) Determination & Treatment
90868 – TMS Daily Treatment
90869 – TMS MT Re-Determination & Treatment
Additional codes are used for psychiatric evaluation, evaluation & management [E/M], outpatient psychotherapy, and psychological testing.
Download the full ICD-10 and CPT coding information here.
BrainsWay offers reimbursement support services to assist practices in delivering optimal care to patients who are eligible for Deep TMS treatment.
*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.