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The Guide to TMS
Therapy Insurance
Coverage

Transcranial magnetic stimulation (TMS) therapy has gained recognition as an effective treatment for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and other mental health conditions. Many insurance providers are now covering it, allowing patients to save between 30% and 100% of costs. Our directory lists verified TMS centers nationwide that accept various insurance plans. Learn more about how to check your benefits and minimize out-of-pocket expenses.

The Guide to
TMS Therapy Insurance
Coverage

Transcranial magnetic stimulation (TMS) therapy has gained recognition as an effective treatment for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and other mental health conditions. Many insurance providers are now covering it, allowing patients to save between 30% and 100% of costs. Our directory lists verified TMS centers nationwide that accept various insurance plans. Learn more about how to check your benefits and minimize out-of-pocket expenses.
Table of Contents

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Insurance Cover TMS

Insurance Companies
Providing TMS Coverage

Most insurance companies now reimburse TMS therapy if the patient meets specific criteria. This treatment is gaining popularity due to its high effectiveness, non-invasive nature, and long-lasting results. Patients can have their TMS covered if they have an insurance plan from one of the following providers:

TMS Insurance Coverage for Depression: Eligibility Criteria

While coverage specifics can differ, standard eligibility criteria include:
Adult status (18+ years old) for most treatments. Adolescents (15+) are eligible only for depression treatment with NeuroStar devices
A documented diagnosis of MDD, as per DSM-5
One or more of the following:
  • Unsuccessful trial of one antidepressant medication or the lack of response to electroconvulsive therapy
  • Positive reaction to rTMS treatment with a 50% improvement in symptoms
  • A medical condition that makes it unsafe to use antidepressant medications
After reviewing the submitted documents, your health insurance company will decide to either have your TMS therapy covered or deny the request, which can be later appealed.
TMS providers must ensure that the patient does not have seizure disorders or other medical conditions that can put them at risk of complications. People with magnetic-sensitive metal implants less than 10 cm near the coil are not eligible for TMS.
TMS Insurance Coverage for Depression

TMS Insurance Coverage for OCD: Eligibility Criteria

TMS treatment for OCD will be covered by insurance if prescribed by a licensed psychiatrist trained in TMS application and if the patient meets the following criteria:

Confirmed DSM-5 diagnosis of OCD
One or more of the following:
  • Persistent OCD symptoms after at least 8 weeks of trials of two medications or one medication plus psychotherapy
  • Inability to tolerate two distinct psychiatric medications
  • History of positive response to TMS for OCD
  • Persistent OCD symptoms despite 8 weeks of exposure and response prevention (ERP) therapy
  • If currently taking medications with higher risk profiles, TMS may be considered a reasonable alternative
TMS Insurance Coverage for OCD
The treatment order must come from a psychiatrist who has examined the patient, reviewed their records, and prescribed an evidence-based TMS protocol for OCD. This overseeing physician does not need to perform the TMS sessions personally. However, they must be accessible when necessary.
TMS generally has a very low risk of seizures, but precautions should be taken for patients with specific disorders or medical conditions that increase seizure risk. An assessment weighing potential treatment benefits against side-effect risks should be made.
TMS is contraindicated for OCD patients with magnetic-sensitive medical devices less than 10 cm from the TMS coil, such as cochlear devices. However, MRI-safe aneurysm clips, stents, staples, dental amalgam fillings, spinal fusion hardware, and nerve stimulators are acceptable for use with TMS.

TMS Insurance Coverage for Short-Term Smoking Cessation: Eligibility Criteria

TMS for smoking cessation will be covered if prescribed by a licensed provider trained in TMS who confirms that the patient meets the following criteria:
Diagnosis of Tobacco Use Disorder per DSM-5
One or more of the following:
Persistent symptoms after 4-week trials of:
  • One nicotine replacement therapy
  • One smoking cessation medication
  • One course of evidence-based counseling
  • Inability to tolerate smoking cessation medications
  • History of smoking-related health conditions, such as lung cancer, COPD, arterial disease, and others
  • Positive response to TMS for smoking cessation in the past, defined as at least 4 weeks of abstinence
TMS Insurance Coverage for Short-Term Smoking
The treatment order must come from a provider who has examined the patient, reviewed their records, and prescribed an evidence-based TMS protocol. If onsite and interruptible (available when needed), this overseeing professional does not need to perform the TMS themselves.
Precautions should be taken for patients with seizure disorders or related medical conditions. The potential benefits and side-effect risks must be weighed. TMS is contraindicated for OCD patients with magnetic-sensitive medical devices less than 10 cm from the TMS coil.

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Let us help simplify your path to wellness. Contact us today and connect with a TMS center to verify your insurance coverage for TMS therapy. Our team is here to answer all your questions and help you start your treatment with peace of mind.
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