Insurance coverage varies by clinical indication, country/state, and insurance plan.
Major Depressive Disorder (MDD) / Anxious Depression
Treatment for depression and anxious depression is broadly covered in the United States by major private health insurers, including United Healthcare, Anthem, Aetna, Cigna, and Humana, as well as by Medicare and Tricare.
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.
Coverage requirements and payment varies based on specific insurance plans.
Obsessive-Compulsive Disorder (OCD)
On the strength of FDA-clearance, peer-reviewed clinical evidence, and real-life clinical success, many public and private insurance carriers are now offering coverage for Deep TMS treatment of OCD.
This includes Centene, covering 25 million members in all 50 states, including Medicaid and Medicare members, as well as individuals and families served by the Health Insurance Marketplace, the TRICARE program, and commercial insurance. Palmetto GBA, covering nearly 10 million Medicare patients, and BCBS HCSC, including 17 million members in five states, also cover BrainsWay treatment of OCD.
With FDA-clearance in 2020 and growing evidence of success from real clinical usage, BrainsWay is pursuing insurance coverage for Deep TMS treatment of Smoking Addiction.
Prior authorization is typically required to initiate 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.
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 your healthcare provider and/or insurance carrier, or reach out to BrainsWay’s reimbursement support team for assistance.
Three Distinct CPT Codes have been created by the AMA for TMS treatment:
Additional codes are used for psychiatric evaluation, evaluation & management [E/M], outpatient psychotherapy, and psychological testing.
Full ICD-10 and CPT coding information can be downloaded at the bottom of this page.
BrainsWay offers reimbursement support services for your practice as it seeks to provide optimal care to your patients who are eligible for 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.
Download Reimbursement Resources