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 they 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 server 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! 

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