Does Blue Cross Blue Shield Cover TMS Therapy?

Does Blue Cross Blue Shield Cover Transcranial Magnetic Stimulation (TMS)?

Transcranial Magnetic Stimulation (TMS) may be covered by Blue Cross Blue Shield (BCBS) of Tennessee if TMS therapy is medically essential and the patient meets all required criteria.¹ Your Blue Cross Blue Shield TMS coverage details will depend on your particular benefit plan.

Jump to Section

• Does Blue Cross Blue Shield Cover Transcranial Magnetic Stimulation (TMS)?
• How to Verify TMS Therapy Blue Cross Blue Shield Coverage
• BCBS TMS Coverage Eligibility Policy
• What is Transcranial Magnetic Stimulation?
• How Much Does TMS Cost Without Insurance?

How to Verify TMS Therapy Blue Cross Blue Shield Coverage

Athena Care, a TMS clinic in Tennessee, is in-network with most major insurance plans. Find out if your insurance provider can help with the costs by calling your insurance company or by contacting us below. One of our care coordinators can help you navigate your insurance coverage and help you get the care you need.

BCBS TMS Coverage Eligibility Policy

Blue Cross Blue Shield TMS coverage is considered medically necessary when the patient meets ALL of the following medically appropriate conditions:

• 18 years of age or older
• Confirmed diagnosis of severe major depressive disorder (MDD) (first or subsequent episodes) as determined by a standardized-rating scale that accurately evaluates depressive symptoms.
• Failure of a psychotherapy trial

ANY OF THE FOLLOWING MUST BE RECORDED:

• Four trials of psychopharmacologic drugs for depression failed, involving two different agent classes. At least one of the treatment trials had to be provided as an adequate mono- or poly-drug therapy course.
• Four trials of psychopharmacologic drugs with documented adverse effects show an inability to tolerate a significant therapy dose.
• Response to TMS in the past during a depressive episode
• Individual qualifies for electroconvulsive treatment (ECT) not clinically superior to TMS.

ALL OF THE FOLLOWING ARE MISSING:

• Pregnancy
• Ongoing substance abuse
• In the current depressive episode, the presence of acute or chronic psychotic symptoms/disorders, such as schizophrenia
• Epilepsy, history of seizure disorder with an increased risk of future seizures, cerebrovascular illness, dementia, elevated intracranial pressure, history of recurrent or severe head trauma, and primary or secondary central nervous system malignancies are all examples of neurologic disorders.
• Cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, and gunshot fragments are examples of magnetic-sensitive medical devices placed 30 cm or fewer from the TMS magnetic coil.

Furthermore, any device used in this treatment must be FDA approved for the specific indication.

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for delivering electrical stimulation to the brain in patients with treatment resistant depression (TRD) and other psychiatric and neurologic illnesses.

The procedure entails placing a tiny coil on the scalp and passing a quickly alternating current via the coil wire. The electrical current creates a magnetic field that penetrates the scalp and bone without obstructing, stimulating neural activation.  

TMS therapy treatment will not be available to people with specific medical implants. When metal implants or gadgets interact with magnetic fields, they might cause issues. In addition, you may not be eligible for TMS therapy if you have stents, implanted stimulators, a pacemaker, a medicine pump, cochlear implants, or gunshot fragments in your body. It’s critical to discuss these concerns with your doctor before TMS therapy to avoid any consequences.

TMS is also not suggested for persons who have specific medical conditions. For example, those with a history of seizures or who suffer from bipolar illness should avoid TMS therapy. It is also not advised for pregnant women.

Finally, inform your TMS doctor about any prescription or over-the-counter medications, supplements, or vitamins you’re taking. Depending on anything you’re regularly taking, they’ll need to ensure that TMS therapy is safe for you.

Does Blue Cross Blue Shield Cover TMS for Depression?

Yes, Blue Cross Blue Shield (BCBS) does typically provide coverage for Transcranial Magnetic Stimulation (TMS) therapy for Major Depressive Disorder (MDD), including cases of Treatment Resistant Depression (TRD), when certain conditions are met.

TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain and has shown effectiveness in treating MDD, especially in instances where traditional medication treatments have not brought about desired results.

Does BCBS Cover TMS for Anxiety, ADHD, PTSD and Bipolar Disorder?

TMS has shown effectiveness in treating several mental health disorders including Anxiety, Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress (PTS), and Bipolar Disorder. It’s noteworthy that the extent and specifics of coverage can vary depending on the individual’s plan and their specific diagnosis.

However, the specifics of coverage can vary and are subject to certain criteria. It’s always advisable to call us at Athena Care to understand the extent of your plan’s coverage. This ensures you have the most accurate and up-to-date information regarding your mental health treatment options and their associated costs.

How Much Does TMS Cost Without Insurance?

The following are average costs for TMS therapy without insurance, though these costs may vary by location and other factors. Furthermore, they may not reflect the actual cost of treatment or what you may pay in Tennessee.

TMS therapy sessions typically cost between $400 and $500 per session.² Because most people require multiple TMS therapy sessions to achieve optimal outcomes, the total cost of TMS therapy could be about $15,000.

TMS Treatment Center Near Me That Accept BCBS Insurance

If you’re searching for “TMS treatments near me” that accept Blue Cross Blue Shield (BCBS) insurance, you’re in luck. AThena Care has numerous TMS treatment centers in Tennessee that accept BCBS insurance and provide high-quality care for individuals battling various mental health conditions.

Athena Care has established treatment centers in cities like Nashville, Franklin, Murfreesboro, Hendersonville, Clarksville, Memphis, and Knoxville. These local centers offer TMS therapy, a non-invasive, FDA-approved treatment used for patients with conditions like Major Depressive Disorder (MDD) and Treatment Resistant Depression (TRD). Whether you’re searching for the “nearest TMS therapy in my area” or “local TMS treatments,” Athena Care’s numerous locations make it a convenient option.

Moreover, Athena Care’s commitment to delivering evidence-based treatment under the guidance of skilled professionals ensures a high standard of care. With BCBS insurance accepted at these centers, patients can access the help they need without undue financial stress. So, if you’re in Tennessee and looking for accessible, quality TMS treatment, Athena Care’s centers are worth considering.