Is TMS Covered by Insurance? A Clear Guide to Requirements and Next Steps

Key takeaways

• Most insurance plans cover TMS, including private insurance, Medicare, and Medicaid, but typically only for severe depression, despite FDA clearance for other uses.
• Eligibility requirements vary by insurer. Common criteria include two or more failed medications and psychotherapy trials, a psychiatric evaluation and diagnosis, and a high score on a symptom severity scale.
• The TMS clinic handles prior authorization and appeals, so it’s important to work with a provider like Radial that understands TMS insurance coverage.

If you’ve been struggling with mental health symptoms for months or years, you may be considering transcranial magnetic stimulation (TMS) — and wondering, is TMS covered by insurance?

TMS uses electromagnetic pulses to stimulate neurons and regulate brain activity, offering an alternative to antidepressants. According to a small study in the American Journal of Psychiatry, one advanced TMS protocol reported remission rates as high as 79%, compared with 35% after multiple antidepressant trials. If TMS sounds promising, understanding whether your insurance will help cover it is an important next step.

While we can’t answer every insurance question in one article, this guide breaks down TMS insurance coverage, including eligibility requirements, the approval process, and how much you might pay out of pocket.

Is TMS covered by insurance?

TMS is covered by most insurers, but usually with conditions that must be met through a process called prior authorization. Prior authorization is a formal process where your insurer gives approval before you start TMS. 

“TMS requires prior authorization,” says Maryellen Eller, MD, a board-certified adult psychiatrist and the Southeast Regional Medical Director for Radial. "There is variability between insurance companies on what is required and what treatments someone has to fail before authorization will be approved."

“Failed” treatments are those that didn’t work for the underlying mental health condition, typically medications or psychotherapy (talk therapy).

Which conditions are commonly covered?

Most insurance companies cover TMS for major depressive disorder (when other treatments have not helped), but they don’t always cover other FDA-cleared uses such as obsessive compulsive disorder, migraine disorders, or smoking cessation.

TMS for depression has been FDA-cleared since 2008 when it was demonstrated to be effective at treating depression with minimal side effects. That means it’s safe and it works. In one study published in Psychiatry Research, over 81% of those with major depressive disorder experienced a reduction in symptoms in as little as 20 sessions.  

Major depressive disorder is just one of the conditions TMS is FDA-cleared for. The complete list of conditions includes:

• Major depressive disorder (MDD) 
• Anxious depression
• Obsessive-compulsive disorder (OCD) 
• Migraines
• Smoking cessation

There are also emerging uses which are not yet FDA-cleared, but more and more evidence supports TMS’ efficacy for these conditions:

• PTSD
• Peripartum depression (both during pregnancy and postpartum)
• Bipolar disorder (specifically bipolar depression)
• Schizophrenia (specifically for auditory hallucinations)
• Addiction
• Parkinson’s disease
• Stroke recovery

While most insurance companies cover TMS for major depressive disorder (when other treatments haven’t worked), it’s a different story for other FDA-cleared uses. Case in point: OCD. Dr. Eller explains, “Even though TMS has a FDA indication for the management of OCD, not many insurance companies will provide coverage for managing OCD.” 

In reality, insurance companies are slow to cover new technologies, even when the FDA has given the green light, according to a cross-sectional study published in JAMA Health Forum.

Dr. Eller also mentioned that insurance companies can be a bit inconsistent about what conditions qualify someone for TMS coverage, which is why it’s important to work with a TMS clinic like Radial that understands the ins and outs of coverage. It can also be helpful to look up your insurance company's TMS eligibility criteria online. A quick internet search can help you gather information prior to your TMS consultation.

How much does TMS cost with insurance?

The cost of TMS therapy covered by insurance differs depending on the copay (a set amount per session) or a coinsurance (a percentage of the treatment cost) that the patient must pay out-of-pocket. 

This amount varies by insurance plan, though Dr. Eller says many have a copay between $20-50 per TMS session. Most people need 30-36 sessions, meaning the total out-of-pocket costs for 36 TMS sessions would be $720 for someone with a $20 copay, $1,800 with a $50 copay.

Some insurers require you to pay a deductible before coverage kicks in. If your deductible is $2,000 and you haven’t met it, you’d pay that amount out-of-pocket before insurance covers TMS. If you’ve already met your annual deductible, you’ll generally only pay your copay or coinsurance.

There is another detail that impacts price: whether the provider is in-network or out-of-network. Providers who are in-network are contracted by your insurance company at an agreed-upon rate; out-of-network providers are not. “Most people can have a significant difference in out-of-pocket cost for a covered treatment based on if it's being provided by an in-network clinic or an out-of-network clinic,” explains Dr. Eller.

If you pay out of pocket without insurance, a full course of TMS at Radial can cost $3,000-$10,000+, depending on the protocol and location.

The best way to confirm your actual TMS therapy cost is to ask your clinic for a personalized estimate. Often, the clinic's care navigator can run an insurance benefits investigation and see if you may qualify for any additional cost-saving benefits. Radial offers a sliding fee scale for individuals seeking treatment not covered by insurance.

Which TMS treatments are covered by insurance?

TMS has multiple types, each with its own FDA status, and insurance coverage varies by TMS protocol.

Repetitive TMS (rTMS)

rTMS is the original TMS protocol where someone attends one to two daily sessions over four to six weeks. It consists of the gradual delivery of repeated electromagnetic pulses to targeted parts of the brain, and each session lasts about 30 minutes. 

Repetitive TMS is routinely covered by insurance to treat people with moderate to severe major depressive disorder (MDD) diagnosis who failed interventions of medications and psychotherapy. 

Theta burst stimulation (iTBS)

Theta burst stimulation involves TMS pulses delivered in bursts, which mimic natural brain waves, according to research in Clinical Neurophysiology. iTBS sessions are typically shorter, lasting three to ten minutes, because the more natural brain wave pattern means the magnetic pulses can be delivered at higher frequencies and in shorter bursts. 

FDA-cleared since 2018 for depression, theta burst stimulation may even be more effective than rTMS, per research published in Molecular Psychiatry. Despite this, “many insurance companies will consider theta burst to be investigational, even though it is FDA-cleared,” says Dr. Eller. That means this type may be more difficult, but not impossible, to get covered by insurance.

Deep TMS (dTMS)

This category of TMS penetrates a bit deeper into the brain with the use of a differently shaped coil (often the BrainsWay H-coil), according to research published in the Journal of Neural Transmission. By going deeper, dTMS can offer additional mood regulation benefits and is a good option when someone doesn’t respond to other forms of TMS, though it can also be used as the first choice for TMS therapy.

dTMS has been FDA-cleared since 2013 and has racked up solid evidence supporting its effectiveness, per research published in Brain Stimulation. This type is covered by many insurance providers, though it may not be as widely covered as rTMS. 

Retreatment and maintenance TMS

Some people benefit from additional TMS sessions after the initial treatment round, which may reduce the risk of a relapse, according to research published in the Journal of Personalized Medicine. This is called maintenance TMS. It's used to prevent depression recurrence and is generally not covered by insurance.

While the majority of individuals who achieve depression remission with TMS remain in remission for at least a year, some people's symptoms can recur sooner than that. Retreatment because of disease recurrence is different from maintenance TMS. In documentation, it will likely be referred to as a “new onset of recurrence” for treatment during relapse. 

Most insurance companies will cover additional rounds of TMS if your depression symptoms recur. Each payer has different requirements that must be met for retreatment, which often includes at least a 50% symptom reduction during your previous TMS treatment episode. 

Sometimes insurance companies also require a certain amount of time must pass between TMS treatment rounds. Others require that an oral antidepressant be added to your treatment regimen before they'll consider covering a second treatment round of TMS. Speak with your clinic's care navigator to learn more about your specific retreatment benefits.

Is accelerated TMS covered by insurance?

Getting insurance coverage for accelerated TMS can be more challenging than getting coverage for other TMS protocols.

As the name suggests, accelerated TMS compresses the time it takes to complete TMS treatment into a matter of days (instead of weeks). Patients typically undergo five or more treatment sessions a day, completing the entire acute treatment in about a week. That means people often see results quicker, which can be a lifesaver when dealing with severe depression. 

Within accelerated TMS, there are several types to know about:

• SAINT TMS: A protocol that has been FDA-cleared since 2022, is completed in five days with 10 treatments delivered each day. It offers a higher remission rate (as high as 90% according to one small study published in the American Journal of Psychiatry) due to high-precision targeting involving an fMRI.
• SWIFT protocol: FDA-cleared in 2025, BrainsWay SWIFT Deep TMS uses a deep TMS coil, combining the benefits of dTMS on an accelerated time frame. and accelerated. The treatment course includes six treatment days spread over a two-week period. Five treatments are delivered each day followed by a 4-week, weekly taper period.
• AMPA accelerated protocol: Ampa One is a TMS system designed for ONE-D accelerated protocols, which involve 20 treatments administered over the course of a single day.

SAINT TMS coverage – and insurance coverage for accelerated protocols in general – is less common than coverage for other TMS types like rTMS. “Some insurance companies will pay for it,” says Dr. Eller, “And some will not. We are actively advocating to get that coverage extended, because it has demonstrated that it is as good, if not better, than traditional TMS. It works more quickly, and for many clients, it's easier.”

The best TMS treatment for you is usually as simple as finding the protocol you can start and finish. Many people find it easier to commit to a 1-day, 5-day or 6-day treatment protocol compared to treatments every day for six weeks.

What are the eligibility criteria for TMS insurance coverage?

TMS insurance coverage criteria can vary by insurer or plan but typically requires a qualifying diagnosis, significant symptoms, and documented treatment failures with antidepressants and psychotherapy.

Diagnosis and severity of symptoms 

Someone must have the “right” diagnosis, according to most insurers. This diagnosis must be from a mental health provider (i.e. a licensed therapist, psychologist, psychiatrist, or psychiatric nurse practitioner), not a primary care provider. Typically, most insurers will cover TMS for treatment-resistant depression, though some may also cover it for other FDA-cleared conditions. 

Someone’s depression most likely has to be severe, which is determined using a clinical assessment and a standardized scale. There are a select few payers that will cover TMS for MDD-TRD that is "moderate to severe" based on standardized rating scales (most commonly used is the PHQ-9).

The most commonly accepted scales for depression are:

• The Patient Health Questionnaire-9 (PHQ9) 
• The Montgomery and Åsberg Depression Rating Scale (MADRS)
• The Hamilton Rating Scale for Depression (HAM-D)

Failed medication trials

Next, someone must demonstrate that they took two or more antidepressants at a therapeutic dose for 8 weeks or more (exact number depends on the insurer), and either their symptoms didn’t improve or they couldn’t tolerate side effects. What is considered a "therapeutic dose" varies by medication. Insurance companies may even request documentation that the patient took each medication for a therapeutic duration, usually a minimum of eight weeks, unless side effects were so severe, they had to stop before the eight-week mark. 

Dr. Eller also advises to review what your policy defines as “failure,” as the definition varies greatly. In some policies, for example, the failed medication trials need to have occurred within the last twelve months, meaning an unsuccessful stint with Prozac ten years ago might not count.

Failed psychotherapy

Many insurance companies also require that a patient has tried and failed evidence-based psychotherapy treatment. For talk therapy to meet these criteria, it has to be rooted in a structured therapeutic intervention (think: cognitive behavioral therapy or interpersonal therapy). 

“If you went to a therapist and you met with them one on one, but you don't know what type of therapy you received,” says Dr. Eller, “It's very possible that that might not qualify as an evidence-based approach for insurance.” 

The duration for failed psychotherapy is much vaguer. “It should be long enough that we would expect it to work,” says Dr. Eller, “but there's usually no specific time limits on how long you need to be in therapy.” On average, the payers that require a trial of evidence-based psychotherapy require a trial of 8-weeks or longer.

Which plans cover TMS?

Many commercial insurance plans cover TMS, but they all have different requirements. 

As a federal insurance program, Medicare is more standard. Traditional Medicare does cover TMS when three standards are met: 

• The patient has MDD with severe symptoms.
• They have failed one medication and/or weren't able to tolerate the medication’s side effects.
• A psychiatrist has examined the patient and their medical history and recommended TMS.

Medicare Advantage is harder to predict, since these plans are delivered by private insurance companies, says Dr. Eller. In theory, they should cover the same services as original Medicare, including TMS, but they may have different eligibility requirements. 

Does Medicaid cover TMS?

Medicaid coverage for TMS varies based on where you live, and it’s administered through each state. For example:

• In New York, TMS is covered when someone has major depressive disorder and did not improve on two medications. 
• Indiana requires a MDD diagnosis, as well as either four failed medications or a history of response to TMS in a previous depressive episode. Medicaid in Indiana may also cover it when someone switches from ECT to TMS.
• Other states, like West Virginia, don’t even mention TMS in their Medicaid-covered psychiatric services. 

All this is to say, if in doubt check with your insurance provider or a TMS clinic. “It's really valuable to just call the number on the back of the insurance policy card,” explains Dr. Eller, “or to reach out to a clinic, share your insurance information with them, and have them run your benefits to get a more straightforward answer on whether insurance covers these treatments or not.”

How to get insurance approval for TMS

To get TMS covered by insurance, your provider must gather and submit documentation showing that you meet the insurer’s eligibility criteria and that TMS is medically necessary.

Documentation needed

The TMS clinic will collect and send all documentation to prove medical necessity to the insurance provider. This often includes:

• Psychiatric evaluation with a diagnosis 
• A severity score on a verified scale (i.e. the PHQ-9, HAM-D, or MADRAS for MDD)
• Notes on previous psychotherapies, including the therapeutic approach used
• Medication history with start-stop dates, maximum dose trialed, and medication response or reason for discontinuation 
• Letter of medical necessity, which states why treatment is needed 

Understanding prior authorization

After the clinic submits the correct documentation, the insurer either issues prior authorization or denies coverage. That process usually follows the same steps:

1. TMS clinic or patient checks that their benefits include TMS coverage.
2. TMS provider gathers all documents listed above.
3. They send those documents to the insurance provider, who reviews in-house.
4. The insurer sends a decision, usually an approval or denial. 

How Radial supports you throughout the process

The prior authorization process is overwhelming, but most of it is handled by the TMS clinic. That’s why it’s important to work with a clinic like Radial that advocates for their patients and understands the ins and outs of insurance approval.

Alt. text for graphic: “Getting TMS Covered by Insurance”

Medical documentation commonly required for TMS insurance approval includes: a confirmed psychiatric diagnosis, documented symptom severity, psychotherapy history, medication history, and a letter explaining medical necessity. 

What are common reasons for coverage denial?

If TMS therapy is denied by insurance, here are the most common reasons why:

• A history of seizures (TMS has a small chance of inducing a seizure, according to research published in Clinical Neurophysiology. 
• Someone has a metal implant in their brain, which can overheat during TMS and potentially cause brain damage, per the same article in Clinical Neurophysiology)
• There isn’t sufficient medical documentation to demonstrate medical necessity

What to do if your TMS coverage is denied

A TMS therapy insurance denial does not mean you’re out of options. You can still submit an appeal to your insurer or explore other ways to pay. Any time a request for coverage is denied, your insurer is required by law to give you an opportunity to appeal the denial.

How to appeal a denial

If appealing, the TMS clinic will send additional context and evidence around why TMS therapy would be helpful to the insurance company. While the TMS clinic is responsible for the appeal paperwork, they will often collaborate with the patient. 

“Best case scenario, the client and the clinic are collaborating,” says Dr. Eller, “Oftentimes, clients can write a letter to the insurance company that can go along with the peer review or the appeal in an attempt to advocate for themselves, explain the severity of their symptoms, or provide a more extensive history.”

And yes, the appeal process is where the TMS clinic staff either shines or flops. It requires them to put together a comprehensive argument for why treatment is medically necessary as well as why the diagnosed condition hasn’t responded to other treatments. 

Once the appeal is submitted, it typically goes to peer review, which can happen in-house via an expedited process or through a longer process that’s facilitated by an independent third party. 

The first step after the initial denial is usually a peer-to-peer review. In this process, “a physician employed by the insurance company will reach out to one of our clinic physicians,” says Dr. Eller. “We have a conversation, talking through the client's case. The clinic's responsibility is to advocate and demonstrate why this treatment is medically necessary.”

If the patient’s symptoms are manageable, she often recommends the longer process since the appeal is then reviewed by an independent party, not the insurer. Of course, the best route varies on a case-by-case basis, which is something you and your psychiatrist can discuss.  

Other financial options 

“If TMS is recommended, but your insurance company will not provide coverage, either because you don't meet eligibility criteria or in the rare circumstance that they don’t approve, you can always pursue TMS with a cash pay rate,” says Dr. Eller.

Admittedly, that cash pay rate can be high. There are a few ways to make TMS more affordable if insurance doesn’t cover the cost:

• Support from clinics: Since those rates can be high, some clinics offer payment plans and financial support for those who can demonstrate financial hardship.
• HSAs/FSAs: You can also pay with pre-tax dollars set aside in a flexible spending account (FSA) or health savings account (HSA). This lowers your taxable income, offering some savings. Of course, you have to verify a TMS provider actually accepts payments via a HSA or FSA first (for the record, Radial absolutely does).
• Nonprofits: Finally, some nonprofits offer financial assistance. Radial, for example, partners with Living Water to provide financial aid to those who qualify.  

The bottom line

Most insurers cover TMS, but eligibility, covered protocols, and prior authorization and appeals requirements vary. An experienced TMS clinic, such as Radial, can help you navigate the process. 

Frequently asked questions (FAQs) 

How much does TMS therapy cost with insurance? 

The exact out-of-pocket cost of TMS therapy varies based on your insurance provider, the type of TMS, the TMS clinic, and if the insurance provider approves coverage. When it is approved and provided by an in-network clinic, for example, the copay could be as low as $20 per session. For some payers, patients may have no out-of-pocket cost for treatment.

Is TMS covered by insurance for anxiety? 

TMS for anxiety is not covered. That’s because TMS is not FDA-cleared to treat this condition. It is, however, FDA-cleared for anxious depression, and may be covered when anxiety co-occurs with depression. 

Is TMS covered by Medicaid? 

Medicaid may cover TMS, though coverage varies by state. In New York, for example, Medicaid covers TMS for major depressive disorder after failed trials with at least two medications. Meanwhile, West Virginia does not list TMS as a Medicaid-covered psychiatric service.

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