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Does Medicare Cover TMS? The No-BS Answer [2022]

Millions of Americans suffer from depression.  In fact, depression is the leading cause of disability in the United States among adults 18 to 45.

For years, the options for treating depression were limited to electroconvulsive therapy and, later, antidepressant medications.

Transcranial magnetic stimulation (TMS) is a newer treatment option for those suffering from treatment-resistant depression.

Let’s dive into the details of TMS, its cost, and whether it is covered by Medicare and/or private insurance coverage.

What is Transcranial Magnetic Stimulation (TMS)?

TMS is a relatively new treatment for severe major depressive disorder.  It uses magnetic fields to stimulate nerve cells in areas of the prefrontal cortex linked to mood regulation.

Thus far the FDA has approved the use of TMS for the treatment of depression as well as obsessive-compulsive disorder (OCD).

How does TMS work against treatment-resistant depression?

As shown in the diagram below, when the TMS machine is engaged, it directs pulses toward an area of the brain responsible for mood regulation.

The theory underlying this process is that depression results from imbalances between nerve cells in this region.  Artificially stimulating activity in this region can bring the cells back into balance and thereby provide relief to those suffering from severe forms of depression.

In addition to depression, TMS has successfully treated individuals with obsessive-compulsive disorder, bipolar disorder, and seizure disorders.

Diagram showing how TMS works
Diagram showing the effect of TMS on the brain (source: www.MyTransformations.com)

How much does TMS cost?

The price of each TMS session can vary depending on where you live and the number of TMS treatments you require.

The total cost of the procedure can range between $4,000-10,000, with an average price of around $6,500.

Does Medicare cover TMS Therapy?

While most major insurance companies cover TMS for depression treatment, Medicare, unfortunately, does not cover TMS therapy at all.

Private insurers cite the facts that TMS is FDA-approved for the treatment of depression and that several studies have proven its effectiveness.

Why Doesn’t Medicare Cover TMS?

Medicare does not cover procedures considered experimental or non-standard medical practices, even if a physician has been certified to use them. The process of applying for a review of a procedure’s status isn’t easy and can take several months or more before a determination is made.

Below is an explanation from the website of the Centers of Medicare & Medicaid Services:

“There is currently insufficient evidence to show that TMS is reasonable and necessary for the treatment of illness or injury in the Medicare population. Medical policies of commercial insurers also find the treatment not medically necessary.”

The CMS goes on to say that TMS studies are “in their infancy” and that the ability of TMS to “improve outcomes in patients [with major depressive disorder or OCD] is yet to be determined.”

Frequently Asked Questions

TMS is a fairly new form of therapy, which has shown success in treating patients with depression, OCD, and bipolar disorder. The process involves using a wand-like device called a TMS coil to discharge high-intensity magnetic pulses near various areas of the prefrontal cortex—the area associated with mood regulation.

Medicare does not cover TMS therapies, claiming that the technology’s effectiveness has not sufficiently been studied. Note, however, that this very well may be different with private insurance providers, and of course, you can always pay out of pocket. The cost for this treatment ranges from $4,000 to $10,000, depending on your location and the number of treatments you require.

Medicare covers a number of treatments for depression. Medicare Part D plans cover prescription antidepressant medications such as SSRIs. In addition, Medicare Part B covers non-medication treatments for depression, including individual and group psychotherapy (talk therapy, cognitive behavioral therapy, etc.)

Conclusion

Transcranial Magnetic Stimulation therapy is an exciting treatment choice for major depressive disorder and other severe mental health conditions.  Unfortunately, because of how new the technology is, government programs like Medicare do not cover it.

Ultimately, however, if TMS does continue to show results for patients, Medicare will be forced to review its status, hopefully leading to a change in policy.

We hope this piece on Medicare’s coverage of TMS has been helpful.  If you have any questions, please don’t hesitate to leave a comment or send us an email, and we’ll be sure to get back to you within 24 hours.

Warm Regards,
The GetSure Team

  1. Mayo Clinic. 

    (n.d.). 

    Transcranial magnetic stimulation. 

  2. Center for Medicare and Medicaid Services. 

    (n.d.). 

    Transcranial magnetic stimulation. 

  3. Transformations. 

    (October 14, 2019). 

    The Ultimate Patient’s Guide to TMS Therapy. 

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