Does Medicare cover transcranial magnetic stimulation (TMS)?
Aug 23, 2019 · Transcranial magnetic stimulation, or TMS, is a treatment option for depression that has been growing in popularity over the past decade or so. This therapy is non-invasive, shows potential for many clients, and is covered by many Medicare plans.
How many TMS sessions are covered by insurance?
Aug 06, 2020 · Transcranial Magnetic Stimulation for Depression (October 2009, In Press, April 2011): The Blue Cross and Blue Shield Association performed an extensive literature review to evaluate the efficacy of transcranial magnetic stimulation for depression and published its findings as a TEC Assessment in 2009.
What is the CPT code for TMS?
Mar 07, 2022 · 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.
How much does TMS treatment cost?
May 05, 2020 · Does Medicare Cover TMS? May 5, 2020 in Treatment 0 2 If you’re 65 years or older and suffer from depression, you may have wondered, “Does Medicare cover TMS?” Medicare does in fact cover transcranial magnetic stimulation (TMS) treatments.
Is TMS covered by Medi-Cal?
*Please note that, unfortunately, TMS therapy is not a covered benefit through Medi-Cal.
Does Medicare cover TMS for anxiety?
Medicare does not cover TMS therapy for anxiety or other conditions. As with most things covered by Medicare, the Neurostar or other TMS therapy must be performed by a licensed physician who accepts Medicare.Dec 2, 2020
What qualifies you for TMS?
The patient must have a DSM diagnosis of F33. 2 (Recurrent Depressive Disorder, Current Episode Severe Without Psychotic Symptoms) or F32. 2 (Severe Depressive Episode Without Psychotic Symptoms). The severity of depression required, as measured by a clinical rating scale, differs by insurance plan.
How much is the copay for TMS?
If you're paying with insurance, you'll pay anywhere between $10 and $70 per session, depending on your plan's copay or coinsurance rate. (A total of 36 sessions, plus one brain mapping session, are required to complete the treatment course.)Sep 21, 2020
Does Medicare cover TMS for OCD?
Medicare. Medicare typically covers 80 percent of the cost of TMS, with 20 percent billed to the patient. Medicare requires a person to have attempted at least one antidepressant in the past.Mar 16, 2021
Is electromagnetic therapy covered by insurance?
Unsupervised use of ES or electromagnetic therapy for wound therapy will not be covered, as this use has not been found to be medically reasonable and necessary.
Who is not a candidate for TMS?
You may not be a candidate for TMS if: You have implants controlled by physiological signals. This includes pacemakers, implantable cardioverter defibrillators (ICDs), and vagus nerve stimulators (VNS) You are at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.
Who is not a candidate for TMS therapy?
Patients who have experienced seizures in the past or have metal implants or objects around their heads are not suitable candidates for TMS therapy.
Who should not get TMS?
Patients less than 18 years of age or older than 68 years of age. Patients with a history of substance abuse. Patients with a psychotic disorder, such as schizophrenic disorder, schizoaffective disorder, bipolar disease, or major depression with psychotic features.
How long does transcranial magnetic stimulation last?
Treatment sessions vary in length depending on the TMS coil used and the number of pulses delivered but typically last around 30 – 40 minutes. Patients receive TMS 5 days a week. A typical course of rTMS is 4 to 6 weeks. However, this can vary depending on an individual's response to treatment.
Can you do TMS at home?
With at-home TMS, there's no need to travel to a clinic or interrupt your day to make an appointment. The device can be used whenever and wherever you need relief. Another major selling point of at-home TMS equipment is the price.Jul 22, 2020
What are the dangers of TMS therapy?
Common side effectsHeadache.Scalp discomfort at the site of stimulation.Tingling, spasms or twitching of facial muscles.Lightheadedness.Nov 27, 2018
What is transcranial magnetic stimulation (TMS)?
TMS is a fairly new form of therapy, which has shown success in treating patients with depression, OCD, and bipolar disorder. The process involves...
Does Medicare Cover TMS therapy?
Medicare does not cover TMS therapies, claiming that the technology’s effectiveness has not sufficiently been studied. Note, however, that this ver...
Does Medicare cover alternatives to TMS?
Medicare covers a number of treatments for depression. Medicare Part D plans cover prescription antidepressant medications such as SSRIs. In additi...
Document Note
Posted: 8/6/2020 Corrected the typographical error for the statement "Deep TMS (d-TMS) is not considered reasonable and necessary for any condition." to read "Deep TMS (d-TMS) is not considered reasonable and necessary for Obsessive Compulsive Disorder (OCD)." LCD has been posted for a new 45 day notice period of 8/6/20 through 9/30/20.
LCD Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
General Information
This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below. Aetna Clinical Policy Bulletin No 0469. Transcranial Magnetic Stimulation and Cranial Electrical Stimulation. http://www.aetna.com.
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.
Does Medicare cover TMS Therapy?
While most major insurance companies cover TMS for depression treatment, Medicare, unfortunately, does not cover TMS therapy at all.
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.
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.
What is TMS in medical terms?
TMS, transcranial magnetic stimulation, is a noninvasive medical procedure that utilizes magnetic fields to generate electric currents in regions of the brain. An electromagnetic coil is strategically positioned against a patient’s scalp near their forehead to target a region of the brain involved with mood.
What are the limitations of TMS?
There are certain circumstances that will limit a patient’s ability to receive Medicare coverage for their TMS treatments, including: 1 Psychotic symptoms in the current depressive episode. 2 History of seizures 3 The following Neurological conditions: epilepsy, cerebrovascular disease, dementia, increased intracranial pressure or a history of repetitive or severe head trauma 4 Presence of an implanted magnetic-sensitive items located within 30 centimeters from the TMS magnetic coil
How many people have depression in the US?
In 2017, the National Institute of Mental Health (NIMH) estimated that 17.3 million adults in the United States had at least one major depressive episode during a typical year.
Is TMS a good treatment for depression?
Although there are well-known methods for treating depression, such as antidepressant medications and therapy, TMS is one of the most effective treatments, especially if patients do not show positive responses to the former treatments.
Who is the medical director of Mid City TMS?
When treated by licensed, Medicare-approved physicians such as Dr. Bryan Bruno , the Medical Director at Mid City TMS, who are proficient in the administration of TMS, a patient with Medicare is eligible to receive full coverage for the procedures.
Does TMS require anesthesia?
The TMS procedure doesn’t require anesthesia or analgesia and is typically performed in an outpatient setting. Since the magnetic stimulation is focal and non-systemic, TMS usually has no side effects and doesn’t cause memory loss or seizures like electroconvulsive therapy (ECT).
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Transcranial Magnetic Stimulation (TMS). Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy.
Coverage Guidance
Notice: Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits. History/Background and/or General Information Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment that uses pulsed magnetic fields to induce an electric current in a localized region of the cerebral cortex.
What is TMS in brain?
Transcranial magnetic stimulation (TMS) is a non-invasive, non-systemic treatment that uses Magnetic Resonance Imaging (MRI)-strength, pulsed, magnetic fields to induce an electric current in a localized region of the cerebral cortex. An electromagnetic coil is placed on the scalp that induces a focal current in the brain and temporary modulation of cerebral cortical function. Capacitor discharge provides electrical current in alternating on/off pulses. Depending on stimulation parameters, repetitive TMS to specific cortical regions can either decrease or increase the excitability of the targeted structures.
What is Medicare Advantage Policy Guideline?
The Medicare Advantage Policy Guideline documents are generally used to support UnitedHealthcare Medicare Advantage claims processing activities and facilitate providers’ submission of accurate claims for the specified services. The document can be used as a guide to help determine applicable:
Is left prefrontal TMS necessary?
Left prefrontal TMS is considered reasonable and necessary for patients diagnosed with severe Major Depression (single or recurrent episode) as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), who also have at least one of the following:
How many TMS sessions are covered by insurance?
An insurance company defines the number of TMS treatment sessions covered by an insurance policy, and this number often falls between 20 to 40 sessions. In cases where a patient has a deductible, he or she is required to cover the cost ...
How to contact TMS therapy?
To learn more about insurance and TMS or to schedule a free TMS therapy consultation, please contact us online, or call or text us today at 877-257-3193. Categories: Achieve TMS, Blog, Insurance Coverage By Erin Murdoch-Lawley February 4, 2020.
What is achieve TMS?
Achieve TMS is the leading provider of Deep Transcranial Magnetic Stimulation depression treatments. With over 600 patients treated and countless success stories, we’ve brought hope back to those who have been suffering in silence.
How long does it take for a medical insurance company to respond to a claim?
In very rare instances, an insurer may take 30 days or longer to respond. For individuals who are coping with severe depression and believe they may hurt themselves or others, or experience recurring thoughts of suicide or death, call 911 for immediate medical assistance.
What is in network coverage?
In-network coverage ensures an individual can access healthcare providers that agree to accept a specific rate based on an insurance plan. In comparison, out-of-network healthcare providers are not covered by an insurance plan. An individual pays less for medical services delivered by an in-network healthcare provider as opposed to an ...
Does Blue Shield of California have a mental health card?
Blue Shield of California, for example, works with Magellan Health to deliver mental health benefits to its enrollees. But if an individual has a Blue Shield of California insurance card, he or she is unlikely to see any information about Magellan on the card itself.
Do insurance companies require TMS?
Most insurance companies require Achieve TMS to get pre -authorization before TMS therapy is performed. We collect information during an initial patient consultation that allows us to submit a pre-authorization request to a patient’s insurance company.
How to get TMS treatment?
Here are the key requirements for basic Medicare coverage of TMS therapy: 1 You've been diagnosed with severe MDD by a Medicare-approved physician. 2 The treatment provider must be able to accept Medicare's approved reimbursement as full payment for the service. 3 You've previously attempted to treat depression with medication without success, or medication is not recommended for health reasons.
What are the conditions that can be diagnosed with TMS?
You've been diagnosed with neurological conditions such as epilepsy, seizure disorders, or dementia. You have magnetic-sensitive medical devices or objects such as cochlear implants, bullet fragments, or stents near the areas where the TMS devices would be placed.
Why is it important to have accurate treatment records?
Having accurate treatment records is essential. It's especially important if you've stopped taking a medication due to side effects or other complications. Make sure to report your progress (or lack thereof) honestly with your doctors so that they can understand these issues accurately and document your experience clearly.
Can you take medication without success for depression?
The treatment provider must be able to accept Medicare's approved reimbursement as full payment for the service. You've previously attempted to treat depression with medication without success, or medication is not recommended for health reasons.
Is it normal to forget to take medication?
It's normal to forget to take medication once in a while, and sometimes it's hard to make every appointment. And if you aren't feeling better, it's easy to give up before your doctor tries something else. Talk with your provider about adverse effects and give it your best shot, even with the ups and downs.
Does insurance cover TMS?
Insurance companies may not cover TMS therapy in all situations, even if your treatment is medically necessary. Your insurance may not cover TMS treatment if the following apply to you: You are currently pregnant or nursing. You're at acute risk for suicide.
What is transcranial magnetic stimulation?
Transcranial magnetic stimulation (TMS) is a method of delivering electrical stimulation to the brain. In general, single-pulse TMS is used to explore brain functioning and repetitive TMS (rTMS) is used to induce changes in brain activity that lasts beyond the stimulation period (Klomjai et al. 2015). Single-pulse TMS was originally introduced in 1985 as a noninvasive and safe way to stimulate the cerebral cortex. Activation of the motor cortex by transcranial magnetic stimulation produces contralateral muscular-evoked potentials (MEPs), thus providing a valuable tool for functional mapping of the motor cortex. Technological advances introduced generators capable of producing rapid, repetitive pulses of magnetic stimulation. The magnetic field pulses pass unimpeded through the hair, skin, and skull and into the brain where they induce an electrical current to flow inside the brain without seizures or need for anesthesia. The amount of electricity created is very small and cannot be felt by the individual, but the electric charges cause the neurons to become active and are thought to lead to the release of neurotransmitters such as serotonin, norepinephrine and dopamine. Repetitive TMS (rTMS) is currently under investigation as a treatment for several disorders originating in the cerebral cortex including pain, dystonia, epilepsy, headaches, Parkinson’s disease, stroke, and tinnitus. TMS is delivered by various available devices, and treatment has been tested using a variety of protocols, including high frequency delivered over the left dorsolateral prefrontal cortex, low frequency delivered over the right or left dorsolateral prefrontal cortex, bi-lateral delivery, deep TMS in which deeper prefrontal regions are stimulated and theta burst stimulation that delivers magnetic pulses that are administered at a rapid speed of delivery.
What is a NIBS study?
(2020) conducted a systematic review to examine the presence and extent of methodological issues confounding non-invasive brain stimulation (NIBS) studies attempting to alleviate the cognitive symptoms of demented patients. However, serious methodological limitations appear to affect the estimates of their efficacy. The focus was on repetitive transcranial magnetic stimulation (rTMS) or tDCS, i.e., the two most frequent NIBS techniques. Patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) were included. The study reviewed the stimulation parameters and methods of studies that used TMS or tDCS to alleviate the cognitive symptoms of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). The risk of bias was also included in these studies. There were 36 studies identified of which 23 were randomized-controlled trials. More than 75% of randomized-controlled trials involved some levels of bias in at least one domain. Stimulation parameters were highly variable with some ranges of effectiveness emerging. Studies with low risk of bias indicated TMS to be potentially effective for patients with AD or MCI while questioned the efficacy of tDCS. This was the first time the presence and extent of methodical issues affecting TMS and tDCS research involving patients with AD and MCI were examined.. The risk of bias frequently affected the domains of the randomization process and selection of the reported data while missing outcome was rare. Unclear reporting was present involving randomization, allocation concealment, and blinding. Methodological awareness can potentially reduce the high variability of the estimates regarding the effectiveness of TMS and tDCS. Studies with low risk of bias delineate a range within TMS parameters seem to be effective but question the efficacy of tDCS. The study also had limitiations including the lack of quality assessment of the non-RCTs as well as a quanitative analysis. Only the measurements of cognitive domain were considered and most neuropsychiatric symptoms are considered to be closely linked with cognitive disturbances causing reduced quality of life in neurodegenerative disorders. Author’s note that based on the current literature, it is difficult to conclude the effectiveness of NIBS methods in dementia research.
Can TMS be used for tinnitus?
In a clinical practice guideline for tinnitus, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Guideline Development Panel indicated that clinicians should not recommend TMS for the treatment of patients with persistent, bothersome tinnitus (Tunkel et al., 2014).
Is rTMS evidence based?
In a position statement for neuromodulation of chronic headaches, the European Headache Federation states that application of the noninvasive rTMS in chronic headaches is not yet evidence based, given the poor amount of controlled data (Martelletti et al. 2013).
Is NTMS effective for diagnosis?
There is limited information from the peer-reviewed published medical literature to conclude that navigated transcranial magnetic stimulation (nTMS) is effective for treatment planning or diagnostic evaluation. Randomized controlled studies with large populations are needed to evaluate how this technology can reduce clinical diagnostic uncertainty or impact treatment planning.
What is the only magnetic stimulator system approved by the FDA for treating depression?
The only magnetic stimulator system approved by the FDA for treating depression is the NeuroStar® TMS Therapy System (Neuronetics Inc.). This system (product code, OBP) was approved in 2008 for treating adult patients with major depressive disorder (MDD) only when the affected patient has failed to attain satisfactory improvement from at least one antidepressant medication administered in the current depressive episode at or above the minimal effective dose for at least the minimal effective duration and only when TMS is prescribed by and performed under the supervision of a licensed psychiatrist. 4
What is TMS therapy?
A section of the updated guidelines (Section IV) relates to neurostimulation therapies, including TMS, electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), for treating MDD in adults. The subsection for TMS notes that in 2002, Canada approved the use of TMS for treating depressed adults who fail to respond to at least one antidepressant drug. Most available evidence pertains to the use of high-frequency left-sided TMS (HFL-TMS) for this indication. However, direct comparisons among the many open-label studies and randomized controlled studies are hampered by variations in study design and stimulation parameters. Based on available data, the CANMAT recommended that, when using TMS for treatment-resistant MDD, the first TMS approach should be HFL-TMS and the treatment duration should be 30 sessions (3 weeks) instead of 20 sessions (2 weeks). The CANMAT noted that there was minimal evidence regarding the use of TMS for maintaining response/preventing relapse and drew no conclusions regarding TMS for this indication. 5
What is neuromodulation for depression?
Patients with major depression who do not respond to standard treatment with pharmacotherapy and psychotherapy are candidates for noninvasive neuromodulation procedures, including repetitive transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT).
Does TMS show efficacy?
recent TEC report (2009) evaluated transcranial magnetic stimulation for the treatment of depression and summarized that the randomized clinical trial of TMS does not show definitive evidence of efficacy for its primary endpoint at 4 weeks. Not all outcomes show efficacy, and the analysis is sensitive to alternative methods of analysis. Another limitation of this and other studies of TMS is lack of rigorous evaluation beyond the period of treatment. Although short-term studies are consistent with changes in depression scores due to TMS, the clinical significance and durability of the effect are not well characterized. One metaanalysis indicated no difference in effect between patients with treatment-resistant and nontreatment- resistant depression. The randomized, clinical trial showed a greater effect in patients with only one prior treatment failure, with possibly minimal or no effect in patients with greater than one prior treatment failure. The TEC report indicated that the available evidence does not permit conclusions regarding the effect of TMS on health outcomes or compared with alternatives and it has not yet been demonstrated whether TMS improves health outcomes in the investigational setting. 13
Is TMS considered an investigational treatment?
Transcranial magnetic stimulation (TMS) for the treatment of major depression, migraine headaches, or any other diagnosis is considered investigational and unproven as there is insufficient evidence in the peer reviewed scientific literature on whether the effect of TMS improves health outcomes as compared with alternatives.
Is transcranial magnetic stimulation a treatment option?
In the Practice Guideline for the Treatment of Major Depressive Disorder published 2010, transcranial magnetic stimulation is mentioned as a treatment option for patients who do not respond to pharmacotherapy. The guidelines outline the following key points 6: