Does Medicare Cover TMS? 

Today in the United States, there are over two million seniors aged 65 and over who are living with a form of depression, and many of them have symptoms of major depression. For those who have tried other depression treatments that haven’t resolved their health issues, transcranial magnetic stimulation (TMS) may be a solution. 

TMS is a noninvasive FDA-approved medical procedure that can improve the symptoms of major depression by stimulating targeted nerve cells in the brain using magnetic pulses. As of now, the FDA has also approved TMS for the treatment of an obsessive-compulsive disorder, migraines, and smoking cessation. 

During a TMS session, a trained medical professional places an electromagnetic coil on the scalp which sends nerve-stimulating magnetic pulses into the region of the brain that controls mood and depression.  

If you’re experiencing severe depression that isn’t relieved by taking medication, your health care provider might suggest trying TMS, and Medicare might help cover some of your expenses if you are eligible for this benefit.  

Does Medicare cover TMS treatments? 

If you are enrolled in Original Medicare Part B (medical insurance), you can get coverage for TMS therapy if you meet all of the following eligibility requirements:

  • Your health care provider has diagnosed you with major depressive disorder (MDD). 
  • A Medicare-affiliated physician prescribes TMS treatment and does the procedure. 

Furthermore, you must also meet at least one of the following requirements: 

  • You haven’t had a significant clinical response after taking at least four types of antidepressants from at least two different categories of drugs. 
  • You’ve had negative side effects, or intolerance, to at least four types of antidepressants from at least two different categories of drugs. You may qualify if you have a bleeding disorder, or you’ve had trouble managing the adverse effects of the drugs. 
  • You’ve experienced a positive response to TMS in the past. 

If you’re eligible for this benefit, Medicare Part B covers 80 percent of the final approved cost for the TMS therapy treatment and its administration. You pay the remaining 20 percent after covering the annual Part B deductible. 

If you have a Medicare Advantage (Part C)plan, your provider must cover the same benefits that you’d have through Original Medicare Parts A and B. If you meet Medicare’s eligibility requirements for TMS therapy, your provider must cover its portion of the expenses agreed to in your policy. Depending on the type of coverage you have, you may be required to pay a copayment or coinsurance, and you may also need to use health care providers and medical facilities that are included in your plan’s network of approved providers. 

How much do TMS therapy sessions cost without Medicare coverage? 

How much you pay out-of-pocket for TMS therapy depends on where you live, the physician who does your treatment, how many sessions you have, your age, and other health factors. The average national cost for one session of TMS therapy costs between $200 and $300, and one complete course of TMS can cost between $6,000 and $12,000, according to some providers. 

Similar Posts