Repetitive Transcranial Magnetic Stimulation (rTMS or TMS) is a treatment that is FDA-Approved for Major Depressive Disorder and Obsessive Compulsive Disorder (OCD). TMS Therapy involves a device, which is placed on a patient’s head, that is able to awaken parts of the brain that are underactive in individuals with depression and OCD. When TMS first became available to the public in 2008, it was a very expensive treatment. There was only one device available on the market (NeuroStar) which doctors could purchase, but was very expensive. Many doctors charged upwards of $16,000 for an entire course of treatment! Nowadays, there are significantly more options for TMS.
Historically, TMS was initially so expensive for a number of reasons. First, the cost of the machine was so exorbitant that most doctors could not afford to treat people for cheaper. Secondly, the first devices available to the public would charge the doctors between $60 – $100 per treatment. This meant that the doctors would have to make at least $60 – $100 per session, plus pay for a trained TMS technician as well as any related expenses before coming out ahead. Other devices eventually became FDA-Approved, such as Brainsway’s “Deep TMS” machine and MagVenture’s “MagVita” machine. Devices such as the MagVita machine and the CloudTMS machine allowed doctors the freedom to not have to pay for each treatment, which contributed to reducing the cost of treatment. There are two newer machines available now for a total of 7 FDA-approved TMS machines in the United States. The newest machines are Apollo TMS from Germany, which has a robotic arm to hold the TMS coil in place (other machines use a more simple locking mechanism) and NexSTim, which came out of technology used for neurosurgery to image the brain and locate specific neural targets. We’ve seen a lot of patients and providers ask about which machine we use at each location, but in our experience, the machine isn’t nearly as important as the actual treatment protocol itself. In fact, every single machine that is FDA-approved originally filed their FDA application based on how similar they are to the other TMS machines.
TMS is much more affordable now, and not that expensive anymore. Major insurance companies such as Aetna, Cigna, Blue Cross Blue Shield, Blue Shield of California (Magellan), Anthem Blue Cross, and Medicare eventually started paying for TMS in 2013. Now that insurance companies pay for TMS, the treatment is much more affordable for those in need. However, insurance coverage varies among each particular insurance company. For instance, some insurance companies require that the patient has tried at least 4 antidepressant medications in the past. Other insurance companies are much more lenient.
As of 2022, here are the following requirements from the major insurance companies:
- Aetna: 2 antidepressant medications in the past + 1 “augmentation” (timeframe of more than one medication taken concurrently)
- Anthem Blue Cross: 2 antidepressant medications in the past
- Beacon Health Options: 2 antidepressant medications in the past
- Blue Cross Blue Shield: this depends on the specific policy, so you would have to contact our office to find out more. Some plans, like Blue Cross Blue Shield of Illinois, always require 4 antidepressants in the past, while others allow for just 2 previous trials.
- Blue Shield of California (Magellan): 4 antidepressant medications in the past
- HealthNet (MHN): 4 antidepressant medications in the past of at least 2 different classes
- Cigna: 2 antidepressant medications of 2 different classes (e.g., both can’t be SSRI’s)
- Medicare: 1 antidepressant in the past (note that this differs depending on exact geographic location)
- United Healthcare (Optum): 4 antidepressant medications in the past
Note that every one of these companies also requires at least two months of psychotherapy in the past. The easiest way to find out if your insurance will cover your TMS treatment is to fill out our treatment history form, and we will get back to you within 24 hours regarding whether or not your treatment will be covered.
The good news is that there can also be exceptions. For instance, we have a partnership with more immersive programs that may include TMS, esketamine, and group therapy. Insurance is more likely to approve these bundled services together than separately.
As the leading provider for Personalized TMS in Southern California and Las Vegas, we hope to reduce the cost of TMS even more. We believe that everyone deserves the best mental health treatment, regardless of their financial situation. If you or your loved one are interested in learning more about the cost of TMS, please schedule a consultation with us today.
