Is TMS Covered by Medicare?

What is TMS Therapy and How Does It Work?

TMS is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation. During a session, a coil is placed on the patient’s head, delivering pulses that activate the prefrontal cortex, an area often underactive in those with depression. Unlike electroconvulsive therapy (ECT), TMS does not require anesthesia and does not induce seizures, making it a less intensive option with fewer side effects.

Sessions typically last about 20 minutes and are administered daily over six weeks. For many patients, TMS has proven effective in reducing depressive symptoms, especially when other treatments have failed.

Does Medicare Cover TMS Therapy?

Yes, Medicare Part B covers TMS therapy for eligible patients diagnosed with major depressive disorder. However, certain conditions must be met to qualify for coverage:

• Eligibility: You have tried and not responded or had side effects that were intolerable for at least one antidepressant medication
• Coverage: Medicare Part B typically covers TMS under outpatient mental health services.
• Approval Process: Advantage TMS will submit prior authorization to Medicare to confirm medical necessity.
• Medicare Advantage plans also cover TMS.

Key Takeaway: Medicare TMS coverage is available and generally very affordable, with little or no co- pays, depending on your coverage.

How Many TMS Treatments Does Medicare Cover?

Medicare generally covers 36 TMS sessions per treatment course for depression. 

At Advantage TMS, we work directly with Medicare to streamline approvals and ensure you maximize your benefits.

TMS vs. ECT: Does Medicare Cover Both?

Many patients wonder, “Does Medicare cover ECT treatments?” The answer is yes—Medicare covers Electroconvulsive Therapy (ECT) for severe depression. However, TMS is often preferred because:

• Non-Invasive: No anesthesia or memory loss risks.
• Fewer Side Effects: TMS avoids systemic issues like weight gain or fatigue.
• Convenience: Outpatient sessions take just 20 minutes.

Medicare covers both therapies, but TMS offers a safer, more accessible option for many patients.

How Much Does TMS Cost with Medicare?

With Medicare Part B:

• You may be responsible for up to 20% of the Medicare-approved amount after meeting your deductible.
• Medicare Advantage plans generally pay the up to 20% that is not covered by Medicare.

How to Check Your Medicare Coverage for TMS

1. Partner with Advantage TMS: We handle prior authorization and insurance paperwork so you can focus on healing.  We will contact Medicare on your behalf and work with any other insurance carriers and providers you see to get the information we need to secure an authorization for you to begin treatment.

Why Choose Advantage TMS for Medicare-Covered TMS Therapy?

At Advantage TMS, we specialize in helping Medicare patients access affordable, effective TMS therapy. Here’s what sets us apart:

• Medicare Experts: We navigate approvals and paperwork for you.
• Personalized Care: Board-certified psychiatrists tailor treatment to your needs.
• Transparent Pricing: No surprise bills—we explain costs upfront.

Frequently Asked Questions

Q: Is transcranial magnetic stimulation covered by insurance other than Medicare?
A: Yes! Most private insurers (e.g., Aetna, Blue Cross) cover TMS for depression.

Q: Does Medicare cover TMS for conditions other than depression?
A: Currently, Medicare only covers TMS for treatment-resistant depression.

Q: How do I start TMS therapy with Medicare?
A: Schedule a free consultation at Advantage TMS. We’ll verify your coverage and guide you through every step.

Take the First Step Toward Healing

If you’re struggling with depression and want to explore Medicare-covered TMS therapy, Advantage TMS is here to help.  Call (727) 600-8093

Schedule Your Free Consultation  Let us handle the insurance details while you focus on recovery.