Can My Insurance Provider Cover TMS Treatment?

Transcranial magnetic stimulation (TMS) helps treat various mental health conditions. Learn more about TMS treatment here.

What Is TMS Therapy?

If you are struggling with depression, obsessive-compulsive disorder (OCD), or other mental health conditions that affect your quality of life, you may have heard of TMS treatment. But what is TMS therapy, and how does it work?

TMS stands for transcranial magnetic stimulation. It is a non-invasive procedure that uses electromagnetic currents to stimulate nerve cells in the brain involved in mood regulation. TMS can help improve symptoms of depression and other conditions that do not respond well to medication or psychotherapy.¹

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What Happens During a TMS Treatment Session?

TMS treatment involves placing an electromagnetic coil on your scalp near your forehead. The coil delivers repetitive magnetic pulses that induce small electric currents in the brain. These currents activate or inhibit certain neurons. The stimulation lasts a few minutes and repeats several times per session.

A trained clinician usually administers TMS treatment in an outpatient setting. As a non-invasive procedure, you do not need anesthesia or sedation. You can resume your normal activities after each session. A typical course of TMS therapy consists of twenty to thirty sessions over four to six weeks.

How Is TMS Treatment Beneficial?

Research has shown TMS treatment to be a beneficial and effective treatment method for various mental and physical conditions.

Depression

Evidence indicates that TMS is an effective treatment for major depressive disorder (MDD), especially when other treatments have failed or caused intolerable side effects. According to a meta-analysis of eighty-one studies involving more than four thousand patients with MDD, TMS treatment significantly reduced depressive symptoms and increased remission rates compared to placebo.²

Another study found that TMS can accelerate the effects of amitriptyline, an antidepressant treatment for depression. The results showed a significant reduction in depressive symptoms when patients received repetitive TMS with amitriptyline. Patients began reporting these improvements as soon as one week after their first treatment session.³

Obsessive-Compulsive Disorder

TMS therapy may also benefit people with OCD. Obsessive-compulsive disorder causes recurrent and intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The condition often leaves individuals in distress and can significantly impair daily life.

One randomized, double-blind, placebo-controlled trial that involved ninety-nine patients with OCD showed promising results. It tested TMS therapy targeting the medial prefrontal and anterior cingulate cortex, brain regions responsible for OCD symptoms. Patients who received TMS reported a significant reduction in symptoms compared to those who received the placebo TMS, with response rates at the one-month follow-up reaching 45.2% and 17.8%, respectively.⁴

Other Conditions

Other conditions that may benefit from TMS include post-traumatic stress disorder (PTSD), anxiety disorders, bipolar disorder, schizophrenia, chronic pain, tinnitus, stroke recovery, Parkinson’s disease, and Alzheimer’s disease. However, more research is needed to establish the safety and efficacy of TMS therapy for these conditions.

Is TMS Treatment Covered by Insurance in North Carolina?

Most health insurance providers cover TMS treatment. These include Medicare, Medicaid, Anthem Blue Cross, Aetna, Cigna, UnitedHealthcare, and many others. If you live in Raleigh and are looking for TMS, many options are available.

The cost of TMS can vary depending on the provider, the number of sessions, and the location. One course of TMS therapy can range from $6,000 to $12,000. Yet, you may not have to pay this amount if you have applicable insurance coverage.

Criteria for TMS Coverage

Medical history can significantly affect coverage, as TMS is often for treatment-resistant disorders. For instance, some insurance providers may require patients to try various medications and psychotherapy first.

Requirements

Each insurance company has different criteria and policies for covering TMS therapy. You may need to meet certain requirements, such as:

A diagnosis of MDD confirmed by a psychiatric evaluation
Trying at least two antidepressant medications without seeing improvement in your symptoms
Participating in evidence-based talk therapy sessions without seeing improvement in your symptoms
Obtaining prior authorization from your insurance company before starting TMS therapy

To determine if your insurance provider covers TMS in the Raleigh, Durham, Chapel Hill area, contact them directly and ask about your eligibility. You can also ask your TMS treatment provider to help with insurance verification and authorization.

Does TMS Need to Be Performed by a Professional?

TMS treatment needs to be performed by a professional with proper training and certification. The procedure involves electromagnetic pulses to the brain at specific frequencies. Incorrect administration can cause adverse effects such as headaches, scalp discomfort, facial twitching, or seizures.

Therefore, choosing a qualified and experienced TMS provider who can ensure your safety and comfort during the procedure is important.

Does Advaita Integrated Medicine Offer TMS Therapy?

Advaita Integrated Medicine offers a variety of treatments for mental health and substance use disorders, including TMS therapy. Our experienced and certified clinicians deliver TMS therapy. We use state-of-the-art equipment and protocols for safe and effective sessions. Our team will work with you to create a personalized treatment plan that suits your needs and goals. We will also track your progress and adjust the stimulation parameters to optimize your outcomes.

We provide a comprehensive and evidence-based approach to ensure each person reaches their full potential. Other services we offer include psychiatry, psychotherapy, medication-assisted therapy (MAT), integrative wellness coaching, preventative primary care, and an intensive outpatient program (IOP).

What Insurance Does Advaita Integrated Medicine Accept?

AIM accepts most major insurance plans for TMS therapy, including:

Blue Cross Blue Shield (BCBS)
BCBS My Blue with Duke
UNC Health Alliance
North Carolina State Health Plan
Cigna
Evernorth
Optum
United
Aetna
Medicare

All other insurance providers are considered out-of-network.

We will help you verify your coverage and obtain prior authorization from your insurance company before starting treatment. We will also file all insurance claims on your behalf.

Contact Us Today

If you are looking for treatment and live in the Triangle or surrounding areas like Apex, Clayton, or Wake Forest, AIM is here to help. We strive to help you achieve lasting relief from your symptoms and improve your quality of life. To learn more about AIM TMS therapy or schedule a consultation, contact us today.