Understanding TMS Therapy

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 Requirements

1. Diagnosis: You must have a diagnosis of severe major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM).
2. Failed Treatments: Medicare requires that patients have tried at least one antidepressant medications without success, or experienced intolerable side effects from them.
3. Recommendation: A psychiatrist must evaluate and recommend TMS therapy for your treatment plan.  Advantage TMS’s psychiatrist will do this for you. 

Coverage includes the cost of the treatment itself and related medical services, such as evaluations and follow-ups.

What Costs Will You Be Responsible For?

Medicare typically covers 80% of the Medicare-approved amount for TMS therapy under Part B. However, patients are responsible for:

• • Annual deductible: Before Medicare coverage kicks in, you’ll need to meet your Part B deductible.
  • 20% coinsurance: After the deductible is met, you may be responsible for 20% of the Medicare-approved cost of each session.

• However, Advantage TMS doesn’t want cost to keep anyone from receiving the treatment they need, so they can reduce the co-insurance if there is a financial need.  

Supplemental plans, like Medigap or Medicare Advantage plans, may help cover some or all of these additional expenses.

Medicare Advantage Plans

If you’re enrolled in a Medicare Advantage (Part C) plan, coverage for TMS may vary. Most Advantage plans offer additional benefits that could lower your costs further. Advantage TMS will check with your plan to confirm your coverage.

Key Benefits of Medicare Coverage for TMS

1. Non-Invasive and Safe: TMS offers a less invasive alternative to treatments like ECT, with minimal recovery time and few side effects.
2. Earlier Access: Recent updates have reduced the required number of failed antidepressant trials, allowing patients to access TMS sooner.
3. Broad Accessibility: Medicare’s inclusion of TMS makes this innovative treatment available to a wider population, including older adults who may have struggled with depression for years.

How to Ensure Coverage for TMS Therapy

To maximize your Medicare benefits for TMS therapy, follow these steps:

1. Consult with a Medicare-Approved Provider: Ensure that the psychiatrist and clinic (Advantage TMS) offering TMS are approved by Medicare and accept the assignment.  Advantage TMS is proud to be a Medicare provider!
2. Advantage TMS will Verify Coverage: We will confirm your Medicare plan details, including coverage specifics, out-of-pocket costs, and any required pre-approvals.
3. Document Your History:  We will help you make sure that the medication you have taken qualifies for coverage. 

Advantages of TMS at Advantage TMS

At Advantage TMS, we specialize in providing TMS therapy to Medicare beneficiaries. Our team is experienced in navigating insurance requirements and can assist you with verifying your coverage. We prioritize making TMS therapy accessible to all patients, offering support at every step of your journey to better mental health.

If you’re concerned about costs, we also accept Medicare Advantage plans and can help explore additional financial options to reduce out-of-pocket expenses.

Additional Questions Patients Often Ask About TMS Coverage

1. Do I need prior authorization for TMS under Medicare? Yes, Medicare typically requires prior authorization, which involves your psychiatrist submitting documentation to demonstrate medical necessity.  Advantage TMS secures this authorization for you!
2. Can Medicare cover maintenance TMS sessions? Maintenance sessions may not always be covered by Medicare. However, if symptoms return, additional treatment may be approved depending on the circumstances.
3. Are there side effects of TMS? TMS is generally well-tolerated. Some patients experience mild side effects, such as scalp discomfort or slight headaches, which usually diminish after the first few sessions.

Get Started with TMS Today

If you’re struggling with treatment-resistant depression and considering TMS therapy, Medicare coverage could make this option more affordable. At Advantage TMS, we’re here to help you understand your insurance benefits and guide you toward relief from depression. Contact us today to schedule a consultation and take the first step toward better mental health.

There were extensive changes to the Medicare blog – I wanted to minimize the focus on cost because we often waive all co-pays. I also made a copy of it, so hopefully that will be saved too (the copy has all the changes)

For the military one, if we could add Champ VA whenever we mention Tricare that would be great. We now accept Champ VA which covers military spouses, etc.

If the changes on the Medicare document don’t come through, please let me know. Thanks!