Is TMS Covered by Insurance?

Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for depression and other mental health conditions. But many patients wonder: Is TMS covered by insurance?

Quick Answer 

Yes, most major insurance companies cover TMS therapy if it is medically necessary and other treatments, such as antidepressants and psychotherapy, have not worked. Coverage depends on your insurer, diagnosis, and medical history.

When Insurance Covers TMS

1. Medical Necessity Requirement

Insurance usually requires:

• Diagnosis of major depressive disorder (MDD) or similar conditions.

• Documentation that other treatments failed, typically two or more antidepressants and psychotherapy.

• A doctor’s referral and prior authorization.

2. Insurance Providers That Commonly Cover TMS

Most major carriers, including Aetna, Cigna, UnitedHealthcare, Anthem, and Blue Cross Blue Shield, offer TMS coverage. However, requirements vary by state and plan.

3. Conditions Typically Approved for TMS

• Major Depressive Disorder (MDD)

• Treatment-resistant depression

• Sometimes OCD or anxiety disorders (case-by-case basis)

4. Limits and Out-of-Pocket Costs

• Some insurers cover a set number of sessions (e.g., 20–36).

• Patients may still have co-pays or deductibles.

• Additional sessions may require an appeal or medical justification.

Key Points

• TMS is usually covered after medication and therapy fail.

• Prior authorization and documentation are required.

• Major insurers like Aetna, Cigna, UHC, and BCBS cover TMS.

• Coverage varies by state and policy details.

• Out-of-pocket costs depend on deductibles and co-pays.

FAQ

1. Do I need to try medications before TMS is covered?
Yes, most insurers require proof that at least two antidepressants and psychotherapy were attempted.

2. Is TMS covered for anxiety or OCD?
Coverage for anxiety and OCD is limited and typically requires special approval.

3. How many TMS sessions are covered by insurance?
Usually between 20–36 sessions, though more may be approved with medical documentation.

4. Does Medicare cover TMS?
Yes, Medicare covers TMS for treatment-resistant depression when criteria are met.

5. What if my insurance denies TMS coverage?
You can appeal the decision with your provider’s support and additional documentation.

With 30+ years of experience, we help clients navigate insurance approvals for advanced treatments like TMS. Don’t let cost stop your recovery—fill out the form below and see if your plan covers TMS today. Fast, secure, and personalized to your needs.