The cost of Deep TMS treatment is an important question for most patients. The good news is that insurance providers are increasingly recognizing the benefit of TMS treatment for depression, anxious depression, and obsessive-compulsive disorder (OCD) and providing coverage.
Even better, many insurance companies are making requirements for coverage less restrictive. This means that more patients have access to health insurance coverage for Deep TMS than ever.
Read on to learn about Deep TMS coverage for depression, anxious depression, OCD, and smoking addiction.
Many patients seeking Deep TMS treatment for depression or anxious depression are covered by their health insurance. Nearly all major health insurance providers, including United Healthcare, Anthem, Aetna, Cigna, and Humana, as well as by Medicare and Tricare, cover TMS for depression/anxious depression; however, they each have specific criteria that must be met before they provide coverage.
Patients must have a primary diagnosis of major depressive disorder or anxious depression. Most policies also require a certain number of antidepressant and psychotherapy trials which had insufficient outcomes or intolerable side effects. For many providers — and all seven Medicare MACs — the number of failed medications required for TMS coverage is two or less.
Health insurance providers are increasingly covering TMS For OCD. This includes Centene, Palmetto GMA, and BCBS HCSC. In addition to a diagnosis, insurance policies with OCD coverage usually require patients to have failed two medications.
Deep TMS for smoking addiction treatment is not currently covered.
Where covered by insurance, patients will typically need to obtain prior authorization before starting TMS treatment. Providers offering Deep TMS should be credentialed with the insurance carrier. Patients are usually charged a copay or co-insurance per treatment session, taking into account deductibles and out-of-pocket maximums.
If TMS is not provided by the insurance plan or the provider is out-of-network, patients can seek single case agreements.
Patients with coverage questions should contact their health insurance company and Deep TMS provider.
Clinics with coverage questions should contact our reimbursement support team at: