Does Medicare Cover TMS Therapy?

Does Medicare Cover TMS Therapy?

Yes, Medicare covers Transcranial Magnetic Stimulation (TMS) in Tennessee, depending on your specific plan.¹

MEDICARE INSURANCE ELIGIBILITY

• United States citizen
• Aged 65 or older
• Or younger than 65 with disabilities or End Stage Renal Disease

Jump to Section

• Does Medicare Cover Transcranial Magnetic Stimulation (TMS)?
• How to Verify Medicare Coverage for TMS Therapy
• Medicare TMS Coverage Eligibility Policy
• What is Transcranial Magnetic Stimulation?
• How Much Does TMS Cost Without Insurance?

How to Verify Medicare Coverage for TMS Therapy?

Athena Care has multiple TMS clinics in Tennessee and is in-network with most major insurance plans. For more information about whether your Medicare insurance covers TMS, call your insurance provider or contact us below. One of our care coordinators can help you navigate your insurance coverage and help you get the care you need.

TMS Medicare Coverage Eligibility Policy

Medicare transcranial magnetic stimulation coverage is an option for the treatment of depression when you have been diagnosed with severe major depressive disorder (MDD) by a Medicare-approved physician.

Additionally, you must have tried treating depression with antidepressant medications. If you cannot take pharmaceuticals for health reasons or have a history of depression for which medications have failed, you may be able to begin treatment with TMS.

Once you meet your deductible, you will most likely be responsible for paying monthly premiums and 20% of the Medicare-approved amount. Additional TMS Medicare benefits may be available with Medicare Advantage plans.

What is Transcranial Magnetic Stimulation?

TMS therapy is a non-invasive procedure involving a device that creates magnetic fields used to stimulate the brain. These fields seek to change the brain’s chemistry and alleviate depressive symptoms.

A doctor will place the magnetic coil on your head near your forehead. The electromagnet emits a painless magnetic pulse that activates nerve cells in the part of your brain that controls mood and depression. It’s thought to activate brain regions that are less active in depressed people.² Treatment sessions are typically 45 minutes long, with 20 to 30 treatments recommended for maximum results.

TMS therapy treatment is not available to people with specific medical implants. Metal implants or gadgets interacting with magnetic fields can 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. Discussing these concerns with your doctor before the procedure is critical to avoid negative 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. They’ll need to ensure that TMS therapy is safe for you.

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.³ Because most people require multiple TMS sessions to achieve optimal outcomes, the total cost of TMS treatment could be close to $15,000.

Sources

1. Moody, Colleen. “Does Medicare Cover TMS?” Medicare & Medicare Advantage Info, Help and Enrollment, Medicare.org, 18 Mar. 2021, www.medicare.org/articles/does-medicare-cover-tms.
2. Mayo Clinic Staff. “Transcranial Magnetic Stimulation – Mayo Clinic.” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), 27 Nov. 2018, www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625.
3. Porter, Robert. “What Does TMS Therapy Cost? TMS Information | BetterHelp Advice.” Betterhelp, BetterHelp, 20 Apr. 2022, www.betterhelp.com/advice/therapy/how-much-does-tms-therapy-cost