Does Medicare Cover TMS?
Fair Square Medicare

Does Medicare Cover TMS?

smiling man receiving TMS therapy stock photo

By Daniel Petkevich

Oct 21, 2022

Let's Talk About TMS, How It Works, and How to Get Coverage

October is depression awareness month, and we've got mental health care on the brain.

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Since the start of the COVID-19 pandemic, rates of depression, anxiety and other mental health conditions have spiked significantly (and for good reason — self-isolation and sickness can be quite stressful).

But COVID-related or not, mental health care is health care, and depression needs to be treated.

Treatment usually involves medications (i.e., antidepressants), but different people and circumstances require different treatments. Sometimes, alternative therapies — like TMS — are more effective.

So what is TMS? And how do you know if it's right for you?

Let's dive deeper into these questions and discuss how Medicare can help cover treatments.

What Is TMS?

Transcranial Magnetic Stimulation (TMS) is a non-surgical outpatient procedure used to treat depression.

It involves an FDA-approved device that stimulates parts of the brain involved in decision-making, social behavior, personality, and cognitive behavior.

How Does TMS Therapy Work?

Our body consists of a network of neurons that communicate with each other using electrical and chemical signals. But sometimes, these neurons don't do their jobs.

(They're supposed to be active, but ... they decided to take a nap instead).

That's where TMS therapy comes in.

The TMS machine — placed against the scalp near the forehead — contains an electromagnetic coil. Pulses from the coil cause neurons to "wake up."

This reactivates nerve cells in the brain regions responsible for mood regulation — like the left dorsal lateral prefrontal cortex.

TMS | Source: Transformations

How Long Does TMS Therapy Take?

Each session lasts between 20 and 50 minutes.

You may need 20 to 30 sessions to see the most effective results.

Why Is TMS Good for Depression?

Depression can be caused by decreased activity of nerve cells.

When the neurons in our brains are inactive, they fail to communicate effectively with each other. This makes it difficult for us to control our emotions or respond to situations — which can ultimately lead to depression.

TMS solves this issue by activating the nerve cells with electromagnetic stimulations.

Should I Consider TMS Therapy?

You can benefit from TMS therapy if you:

  • Have MDD (Major depressive disorder)

  • Find antidepressants and talk therapy ineffective

  • Experience negative side effects from antidepressants, such as weight gain

  • Can't take medications due to other health issues

However, TMS therapy is not for everyone. Your doctor probably won't recommend TMS if you have the following:

Does Medicare Cover TMS Therapy?

Yes, Medicare covers TMS therapy.

However, you must meet both of the following conditions:

  • You have an official MDD (Major depressive disorder) diagnosis

  • A Medicare-approved physician prescribes and administers your TMS treatment

In addition, you need to meet at least one of the following criteria:

  • Drug Resistance

    • You've tried four or more antidepressants from at least two distinct classes and experienced no significant clinical response

  • Adverse Drug Reaction

    • You have negative side effects or intolerances to four or more antidepressants from at least two distinct classes

      • This includes people with bleeding disorders or patients who have trouble managing the adverse effects of antidepressants

  • Positive response to TMS

    • TMS therapy has worked for you in the past

How Much Does TMS Therapy Cost?

The average cost for TMS therapy is $400–$500 per session. But if Medicare covers your treatment, you won't have the pay the entire amount.

With Medicare coverage, the total cost for your TMS therapy includes:

  • Your Part B deductible

  • 20% of the Medicare-approved amount (Medicare covers 80% of the cost)

Note: If your health insurance plan covers copays and coinsurance, you might pay less than 20% (or nothing at all).

Conclusion

If you're struggling with depression and haven't found relief from antidepressant medications, you might consider TMS. Talk with your doctor before starting or stopping treatment for depression. This content is for informational purposes only.

TMS therapy is an FDA-approved, non-invasive outpatient procedure that uses electromagnetic pulses to target the regions of your brain in charge of mood regulation and decision-making.

And if you're eligible, Medicare will cover at least part of your treatment.

If you have any questions about TMS therapy and coverage, give us a call at 1-888-376-2028. Our licensed agents can provide answers and determine the cost according to your specific health insurance plan.

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