What You Need to Know About Insurance Coverage for TMS Therapy

W. Nate Upshaw, MD

W. Nate Upshaw, MD

Dr. William Nathan Upshaw is the Medical Director of NeuroSpa TMS®. Since receiving training from the inventor of TMS Therapy nearly a decade ago, Dr. Upshaw has been a pioneer, champion and outspoken advocate of TMS Therapy. Dr. Upshaw’s holistic experience in the field has transformed him into Florida’s leading advocate for widespread accessibility to TMS Therapy.

About Dr. Upshaw

Depression affects more than 16 million adults in the USA every year. Typical treatments for depression include psychotherapy and antidepressant medications, however, people often need to try several different medications before finding one that works reliably for them. Like therapy, this process takes time and antidepressant medications often come along with significant side effects. However, there’s a newer and more convenient treatment for relief from depression.

Transcranial Magnetic Stimulation (TMS) is a treatment for depression that uses a powerful electromagnetic coil to stimulate tissues of the brain which are known to contribute to depression. TMS therapy, which is conducted in a clinician’s office, has been FDA-approved for the treatment of depression since 2008 and requires no sedation. During a TMS session, an electromagnetic coil is placed on the patient’s forehead and a series of repetitive, focused magnetic pulses stimulate nerves in the brain, particularly those responsible for one’s mood.

What Insurance Companies Cover TMS Treatment?

TMS therapy is covered by most insurance companies. Many insurance companies pay for TMS therapy for depression because it’s effective and FDA-approved for the treatment of major depressive disorder.

The following insurance companies cover TMS therapy as long as the treatment is medically necessary and company-specific guidelines are observed. Even though an insurance company may pay for a particular procedure like TMS, it’s vital for a potential recipient of these services to check their policy for specifics, including plan limitations. Each insurance company has its own benefits schedule, eligibility requirements, and coverage policies for TMS therapy.

 

The criteria most insurance companies require to be met include:

  • A diagnosis of depression
  • Attempts at resolving depression with antidepressant medications with no significant lasting improvement
  • A history of therapy or counseling carried out by licensed professionals
  • No history of seizures or seizure disorder

Each of these conditions must be met for insurance to cover TMS therapy.

 

The following insurance companies provide coverage for TMS used for the treatment of depression:

  • Aetna. Aetna requires a person to have been on 2 antidepressants in the past without significant improvement.
  • BCBS. Blue Cross and Blue Shield varies by state and policy. Anthem BCBS requires a person to have tried at least 2 antidepressants before covering TMS.
  • Beacon. Beacon requires several criteria to be met, including but not limited to resistance to treatment with psychopharmacologic agents.
  • Cigna. Cigna requires a prospective TMS client to have tried two antidepressants, each of a different class.
  • Humana. Humana requires several criteria to be met, including but not limited to a confirmed diagnosis of severe major depressive disorder.
  • Medicare. Medicare typically covers 80 percent of the cost of TMS, with 20 percent billed to the patient. Medicare requires a person to have attempted at least one antidepressant in the past.
  • Medicaid. Medicaid covers TMS only in Washington state at this time.
  • Meritain Health
  • Tricare. TMS is covered on an outpatient basis.
  • United Healthcare. A client must have tried four antidepressants in the past with no lasting improvement.

 

No insurance provider can deny treatment, however they can refuse to pay for treatment if their policy rules are not followed.

 

TMS for Conditions Other than Depression

Although the FDA approved TMS for treatment of Obsessive-Compulsive Disorder (OCD) in 2018, many insurance companies still do not cover it yet. Furthermore, even though PTSD and anxiety also benefit from TMS, the FDA has yet to approve its use for these disorders. Consequently, insurance companies will not cover TMS treatment for them. If you’re seeking TMS for conditions other than depression, reach out to your insurance company directly to learn if their policy rules offer reimbursement for treatment.

 

Benefits of TMS

If you have depression, TMS has advantages other treatment options don’t. Consider these numerous benefits in comparison with traditional approaches:

  • TMS is completely noninvasive. No pills to remember, no surgery, no inconvenience.
  • Side effects are minimal, including lightheadedness and mild headaches
  • TMS is particularly effective for treatment-resistant depression
  • TMS is effective. Over 50 percent of TMS patients achieve remission from depression within 6 weeks.

 

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

 

Works Cited

 Brain stimulation therapies. (n.d.). Retrieved March 27, 2021, from https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

Challen, R., Brooks-Pollock, E., Read, J., Dyson, L., Tsaneva-Atanasova, K., & Danon, L. (2021, March 10). Risk of mortality in patients infected with sars-cov-2 variant of concern 202012/1: Matched cohort study. Retrieved March 24, 2021, from https://www.bmj.com/content/372/bmj.n579

Commissioner, O. (2008). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved March 27, 2021, from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder

Commissioner, O. (2008). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved March 27, 2021, from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder#:~:text=Transcranial%20magnetic%20stimulation%20(TMS)%20is,certain%20migraine%20headaches%20in%202013.

Risio, L., Borgi, M., Pettorruso, M., Miuli, A., Ottomana, A., & Sociali, A. (2020, November 10). Recovering from depression with repetitive transcranial magnetic stimulation (rtms): A systematic review and meta-analysis of preclinical studies. Retrieved March 29, 2021, from https://www.nature.com/articles/s41398-020-01055-2?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=3_nsn6445_deeplink_PID100090071&utm_content=deeplink

 

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