For those seeking an alternative or supplemental treatment, Transcranial Magnetic Stimulation (TMS) offers a promising path forward. This non-invasive therapy uses targeted magnetic pulses to stimulate specific areas of the brain, with proven results, especially for people who haven’t responded well to medication. It doesn’t require sedation and carries minimal risk of serious side effects.
Of course, one of the biggest deciding factors for any treatment is practical: the price tag. Is TMS covered by insurance? Here’s what you need to know.
How Much Does TMS Cost?
The cost of TMS can vary based on several factors, including the clinic’s location, the specific treatment protocol used, and whether you have insurance coverage. Here’s a quick overview to help you understand potential expenses.
Cost With Insurance Coverage for TMS Treatments
Transcranial magnetic stimulation is covered by insurance in some cases, but not all. Many providers cover TMS therapy for individuals diagnosed with treatment-resistant depression, but the extent of coverage and whether or not you get approved will depend on your insurance provider.
With insurance, out-of-pocket costs per session can range from as low as $10 to $70, depending on your specific plan and deductible. Over a typical course of 20 to 30 sessions, this could total between $200 and $2,500. That said, it’s important to understand the specifics of your coverage, including any pre-authorization requirements and the extent of coverage for TMS therapy. Never be afraid to ask: “Is TMS therapy covered by insurance?”
Cost Without TMS Insurance Coverage
When the answer to, “Does my insurance cover TMS therapy?” is no, the cost of TMS therapy can be more substantial. Individual sessions typically cost between $300 and $500, meaning that a full treatment course can amount to a total cost ranging from $6,000 to $15,000.
Some clinics offer sliding scale fees or payment plans to help manage these costs. We recommend reaching out to the treatment center directly to discuss your financial options and explore any available assistance programs or flexible payment arrangements.
Requirements for TMS Insurance Coverage
Because the answer to the question, “Does insurance cover TMS?” is usually, “It depends,” it’s helpful to know what insurance providers typically look for. Coverage isn’t automatic; instead, it’s based on a set of medical and administrative requirements that determine whether the treatment is considered appropriate and medically necessary for the patient’s condition.
Most insurers will only cover TMS for certain diagnoses, most commonly major depressive disorder, and even then, patients usually need to show that they’ve tried other treatments without success. This often includes a history of medication trials and psychotherapy. Most providers will also ask for detailed documentation and a formal treatment plan from a qualified provider.
Understanding “Medical Necessity”
In the insurance world, a treatment is considered a “medical necessity” when it’s seen as essential for diagnosing, treating, or managing a condition, and when other, more standard treatments haven’t worked. For TMS, this typically means you’ve tried multiple antidepressants and/or therapy without getting better, and your provider believes TMS is a reasonable next step.
Insurance companies usually require documentation from a licensed medical professional that outlines your treatment history and explains why TMS is being recommended now.
Potential Disqualifications
While TMS is considered safe and effective for most people, there are certain situations that might disqualify a patient from getting coverage or from receiving the treatment at all. These might include:
- Pregnancy
- Suicide risk
- Substance abuse
- Neurological conditions
- Certain health
- Magnet-sensitive implants or objects
How to Get Insurance Coverage for TMS Treatments
If you’ve reached out to your provider to ask, “Is TMS covered by insurance?” and determined that they might cover it, there are a few things you can do to help move things in the right direction. Insurance companies want to see that this treatment isn’t a first step but something your care team believes is necessary based on what you’ve already tried. Here are some tips to help you build a strong case for coverage.
Document Your Treatment History
In most cases, your provider will need to submit a clear record of your mental health journey so far. That means documenting every antidepressant, mood stabilizer, or other medication you’ve tried, along with how long you took it, what happened, and why it didn’t work. If you’ve done talk therapy, it’s important to include that, too. An honest, detailed history makes a big difference.
Follow All Prescribed Treatment
Insurance companies also want to know you’ve made a good-faith effort with the treatments you’ve been prescribed. That means following your doctor’s instructions, sticking with therapy or medication as recommended, and being consistent. If something hasn’t worked, your provider needs to be able to show that it wasn’t from a lack of trying.
Attend All Therapy Appointments
Believe it or not, inconsistent therapy attendance can hurt your chances of getting coverage. Insurance reviewers may interpret missed sessions as a lack of engagement, even if that’s not the case. Staying consistent with therapy shows that you’re serious about your mental health and have been actively participating in your care.
Obtain a Doctor’s Letter
This one’s really important. Your provider (often a psychiatrist or PMHNP) should write a letter that outlines your diagnosis, describes your treatment history, and explains why TMS is being recommended now. It should state that TMS is considered a medically necessary treatment for your condition and include any relevant details that could make for a stronger case.
What if You Can’t Get Approved for TMS Therapy Insurance Coverage?
Unfortunately, no matter how hard you try, sometimes insurance companies simply won’t provide coverage for TMS therapy. If you’ve gone through the steps and still can’t get insurance approval, it can feel frustrating, but it doesn’t mean you’re out of options. Most insurances do not cover the 5 day accelerated TMS treatment or TMS treatments for ages 17 and under.
Start by asking the clinic you’re planning on attending if they offer medical financing programs or payment plans. Some treatment centers provide third-party financing or sliding scale options based on income, which can significantly reduce the financial burden.
At the Brain Health Center, the cost for the 5 day accelerated TMS treatment series (50 TMS treatments and complimentary private day suite and lunches) is less than $5,000 — a fraction of the $20,000–$36,000 price tag you’ll see at some other clinics. This more accessible pricing has made it possible for people to travel from all over the world to receive care at our clinic without compromising on quality.
The most important thing is not to lose hope. If you’ve been struggling and nothing else has worked, TMS might still be within reach. Talk to your provider, ask questions, explore your options, and don’t give up. There’s help out there.
Schedule Your TMS Consultation
Is transcranial magnetic stimulation covered by insurance? The answer depends on several moving parts, like your diagnosis, treatment history, and specific insurance plan. Fortunately, it’s not something you have to figure out alone. The best way to get clarity is by speaking directly with a provider who understands the process and can help guide you through it.
At the Brain Health Center, we offer one-on-one consultations with licensed providers to review your medical history, talk through your symptoms, and help determine if TMS is a good fit for you. If it is, we’ll work with you to navigate the insurance process or explore other payment options if needed.
If you’re ready to take the next step, we’re here to help. Contact us today to schedule your TMS consultation today and find out if this treatment could be the solution you’ve been looking for.