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

TMS has earned its reputation as one of the most effective mental health treatments. It uses electromagnetic pulses to stimulate neurons and to  rewire and regulate brain activity, resulting in a high remission rate for conditions like depression, OCD, and anxious depression. But is TMS covered by insurance? As with many insurance-related questions, the answer is yes, but it’s complicated.

After months or years of struggling with mental health symptoms, you find a treatment that sounds promising: transcranial magnetic stimulation (TMS). It offers something different than antidepressants, and that “something different” includes a much higher remission rate (Some studies even suggest that it may be as high as 60-80% when using certain refined advanced protocols for depression compared to 35% after multiple rounds of antidepressants). You’re ready to move forward with TMS when a question pops into your head, “Is TMS covered by insurance?” Many insurers cover it, but they often have a lengthy list of requirements that must be met. 

While we can’t answer all insurance questions in one article, we can provide some pretty in-depth info on TMS insurance coverage, including eligibility requirements, what the insurance approval process looks like, and how much you might pay out-of-pocket. 

Is TMS covered by insurance?

TMS is covered by most insurance companies, though there’s usually a laundry list of conditions attached. The way insurance companies determine if someone meets these conditions is via prior authorization, a formal process where your insurer gives the A-OK 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] have failed before that authorization can be approved.”

And by “failed,” we’re not talking about that high school book report you never turned in or a New Year's resolution you couldn’t keep past January. Insurance providers are looking at failed treatments for the underlying mental health condition, usually medications and psychotherapy, aka talk therapy. 

Which conditions are commonly covered?

TMS has been FDA-cleared since 2008. That means it’s safe and it works. And I really can’t emphasize how well it works; in one study, over 81% of those with major depressive disorder experienced a reduction in symptoms in as little as 20 sessions.  

Speaking of major depressive disorder, that’s just one of the conditions TMS is FDA-cleared for. The complete list of conditions includes:

• Major depressive disorder (MDD) 
• Anxious depression
• 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

In an ideal world, insurance companies would cover treatment of the FDA-cleared conditions, and possibly the emerging uses if we’re being optimistic. In reality, insurance companies are slow to cover new technologies, even when the FDA has given the green light.

While most insurance companies cover TMS for major depressive disorder (when other treatments have not helped), it’s a different story for other FDA-cleared uses. 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.” 

She 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.

How much does TMS therapy cost with insurance?

TMS therapy covered by insurance doesn’t mean the insurance foots 100% of the bill. There’s usually a 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.

For some insurance companies, you may have to pay all costs until you reach your plan’s deductible. If that is $2,000 and you haven’t yet spent any of it, you’d have to pay $2,000 out-of-pocket before insurance kicks in. If, however, you have already met your annual deductible before starting TMS, all costs would be covered, other than the 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.

While these out-of-pocket costs are significant, the TMS therapy cost without any insurance is sometimes upwards of $36,000 per course of treatment—and that is quite a bit higher than the TMS therapy cost with insurance coverage.

Which TMS treatments are covered by insurance?

Just like there isn't one antidepressant or anti-anxiety medication, there isn’t one protocol for TMS. The term actually encompasses multiple types, each with their own FDA and insurance coverage status. 

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 upwards of 30 minutes. 

Since it was FDA-cleared in 2008, it’s one of the most covered types of TMS. rTMS is routinely covered by insurance to treat people with a 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. 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. 

Theta burst stimulation is a beneficial option for TMS, may be more effective than rTMS, and has been FDA-cleared since 2018. 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). By going deeper, dTMS offers additional mood regulation benefits and is a good candidate when someone doesn’t respond to other forms of TMS, though it’s often used as the first choice for TMS therapy.

dTMS has been FDA-cleared since 2012 and has racked up solid evidence supporting its effectiveness. This type is covered by many insurance providers, though it may not be as widely covered as rTMS. 

Accelerated TMS

And now onto the fastest option available: accelerated TMS. As the name suggests, this TMS type yields results in a shorter timeframe. Patients typically undergo five or more treatments sessions a day, completing the entire treatment in about a week. That means people often see results quicker, which can be a lifesaver when dealing with severe depression or OCD. 

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

• SAINT TMS: A protocol that has been FDA-cleared since 2022, is faster than many other TMS types, and offers a higher remission rate (as high as 90% in some trials) due to high-precision targeting involving an fMRI. It is completed over the course of a single week
• SWIFT protocol: FDA-cleared in 2025, the SWIFT protocol is similar to SAINT TMS. With SWIFT, however, a deep TMS coil is used, combining the benefits of dTMS and accelerated. The treatment course takes just over 2 weeks.
• AMPA accelerated protocol: This approach involves 20 treatments administered over the course of a single day.

While it is possible to get insurance coverage for accelerated TMS, it’s not as likely as for other TMS types. “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.”

Maintenance TMS

Some people benefit from additional TMS sessions after the initial treatment round, which may reduce the risk of a relapse. In documentation, it will likely be referred to as a “new onset of recurrence” for treatment during relapse.

When referred to properly, this type of TMS is often covered by many major insurance providers. Some insurance companies even view successful past treatment as evidence that TMS may be effective again, increasing the chance of approval. 

What are the eligibility criteria for TMS insurance coverage?

Getting TMS therapy covered by insurance isn’t an automatic yes. Someone must meet eligibility criteria, which can differ from insurer to insurer. That said, there are some common criteria across insurance plans.

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 also has to be severe, which is determined using a clinical assessment and a standardized scale. 

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 (exact number depends on the insurer), and either their symptoms didn’t improve  or they couldn’t tolerate side effects. 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 this 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 more vague. “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.”

Which plans cover TMS? 

Commercial insurance plans are the Wild West when it comes to TMS coverage. Many cover it, 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. 

Medicaid is also tricky since coverage 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

Now that we’ve gone through when insurance covers TMS, let’s look at what the approval process looks like. The good news: The TMS provider is actually responsible for gathering and submitting all this information—anytime you don’t have to do insurance paperwork is an occasion for a happy dance. But it still doesn’t hurt to understand what the clinic is submitting. 

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 exact therapeutic approach used
• Medication history with dates, doses, and failures
• 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.

What are common reasons for coverage denial?

Common reasons for coverage denial include:

• A history of seizures (TMS has a very, very small chance of inducing a seizure)
• Someone has a metal implant in their brain, which can interfere with the effectiveness of TMS
• There isn’t sufficient medical documentation to demonstrate medical necessity

What to do if your TMS coverage is denied

Let’s say you and your TMS clinic both get a denial letter in the mail. It should cite a reason for denial. Remember: An initial “no” does not mean you’re out of options. You can submit an appeal or explore other ways to pay.

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. 

In the expedited 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 insurance companies cover TMS, though eligibility requirements, the type of TMS covered, and what the prior authorization and appeals process looks like varies. To make the process easier, partner with an experienced TMS clinic that understands the ins and outs of coverage, such as Radial. 

Key takeaways

• Most insurance plans cover TMS, including those through private insurers, Medicare, and Medicaid. Usually these plans only cover TMS for depression, even though it’s FDA-cleared for other uses.
• The eligibility requirements differ by insurance provider. Common requirements include a history of failed trials with medication and psychotherapy, as well as a psychiatric evaluation with a diagnosis and a high score on a symptom severity scale.
• The TMS clinic, not the patient, is responsible for submitting prior authorization paperwork and navigating the appeal process if necessary. That’s why it’s so important to work with a TMS provider like Radial, who is well-versed in how insurance coverage works for this particular treatment. 

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. 

Is TMS covered by insurance for anxiety? 

TMS is not usually covered for anxiety. 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.