How Much Does Transcranial Magnetic Stimulation Cost?

What is Transcranial Magnetic Stimulation?

Before discussing Transcranial Magnetic Stimulation (TMS) cost, let’s be on the same page about what it is.

Transcranial Magnetic Stimulation (TMS) is a procedure that has been FDA-approved to address treatment-resistant depression since 2008. TMS works by targeting a specific area of the brain responsible for mood. It is non-invasive and has few side effects. It is extremely effective for addressing depression, which partially explains why there has been a substantial increase in TMS locations over the past 5 years. Upon hearing about the effectiveness of TMS, the big question for patients becomes how much will it cost and how can I pay for it?

How Much Does Transcranial Magnetic Stimulation Cost?

To understand the cost of Transcranial Magnetic Stimulation, you have to think of TMS as putting your brain through a workout. With any exercise plan, you can’t attend the gym once every 6 months and expect positive results. You need regular visits in order for treatment to be effective. For this reason, standard protocol calls for 36 sessions. Even if not doing the standard protocol, multiple sessions are still required, which can add up.

The price per session depends on insurance rates or individual provider rates.

What Insurances Cover TMS?

Most commercial insurances cover TMS. Commercial insurance, also known as private insurance, is provided by a private company. Examples of government-issued insurance are Medicaid (Medi-Cal) or Medicare. In California, Medicare covers TMS, while Medi-cal (medicaid) does not. In California here are some examples of common insurance providers that cover TMS: Aetna, Anthem Blue Cross Blue Shield, Blue Shield of California, Cigna

For all insurers that cover TMS, a prior authorization is typically required before coverage is approved. If coverage is approved, the next consideration is out of pocket responsibilities. You can call your insurance with the number on the back of your card and ask how much TMS would cost if it is approved. The procedure codes are:

90867
90868
90869

Transcranial Magnetic Stimulation Cost, If Using Insurance

If your provider accepts insurance, the price you pay will depend on your individual insurance plan. You have to take into account deductibles, copays, co-insurance, and out-of-pocket-maximums. The rest will be covered by your insurance company. Below are details explaining what these terms mean.

Deductible

This is the amount of money that you are responsible for before insurance will start to contribute.

Example: If your insurance is billed $100.00, and the deductible is $15.00. You would pay $15.00 and the insurance will pay $85.00. Your next appointments might be covered by insurance in total or partially (with copay/coinsurance).

Copay

This is a set rate of money you pay for a covered health care service after your deductible is met. Just because you meet your deductible and insurance starts to contribute, this does not mean insurance will pay 100% of what is left over. A copay is a contribution from you, with insurance contributing to the rest of the bill.

Example: If there is a $100.00 bill, with a $15.00 deductible. The next service that is billed to your insurance might be $10.00 per visit.

Co-Insurance

This is a set percentage you pay after meeting your deductible.

Example: If a $100.00 bill calls for a $15.00 deductible. The next service that is billed to your insurance might be 30% per visit. If the next visit is $100.00, the co-insurance per visit would be $30.00.

Out-Of-Pocket maximum

This is a set limit that you pay out of pocket. After this maximum is met, insurance covers 100%.

Example: If there is a $100.00 bill, with a $15.00 deductible. The next service that is billed to your insurance might be $10.00 per visit (copay). If you have an out-of-pocket maximum of $150.00, after 15 visits at $10.00/visit, you might expect for all visits for the rest of the year to be covered.

Transcranial Magnetic Stimulation Cost, If NOT Using Insurance

Financing Options

There are many ways to finance the amount not covered by insurance. An example of a finance company is Care Credit. They offer two finance options that are listed below, on their website, and in the video embedded in this section. Copied from the CareCredit website:

Deferred interest financing- For qualifying purchases of $200 or more on the CareCredit credit card, no interest is charged if the balance is paid in full within six, 12, 18 or 24 months.
Reduced APR financing. For qualifying purchases of $1,000 or more on the CareCredit credit card, fixed monthly payments over 24, 36 or 48 months are available. Reduced APR financing for qualifying purchases of $2,500 or more in the CareCredit provider network are eligible for fixed monthly payments of 60 months.

Participating In Research Study

If you can’t afford TMS there are places around the country conducting TMS research that may perform the procedure for free or at a discounted rate. You likely need to join the study to get these benefits.

Cash Payment

The price for TMS can range anywhere from 5k-20k without insurance. If you don’t want to use insurance, it will depend on the provider’s specific pricing per session. The benefits of not going through insurance are typically faster service and not having to submit a prior authorization.

Summary of Transcranial Magnetic Stimulation Cost

The cost of TMS can be expensive. For many people suffering from depression it is worth the money and risk. The chances of TMS improving depressive symptoms are in your favor. However, it is important to note that results are not guaranteed. You will have to pick the plan that is right for you.