Insurance Coverage

DETERMINING COVERAGE

***Each insurance has its own specific requirements so the information below is only a guide.

Patients must have a clinical diagnosis of major depressive disorder and/or obsessive compulsive disorder. Our expert nurse practitioners will complete an assessment to confirm your diagnosis and determine whether TMS is the best treatment option for you.

Most insurance companies require failure of at least 3-5 antidepressants, sometimes from multiple families of medications.

CPT CODES BILLED TO INSURANCE

TMS CPT Codes (what is billed to insurance) are available since January 2011 as follows:

90867 – Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management. You will have 1 of these visits.

90868 – Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session. You typically receive 33 treatments.

90869 – Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management.

COPAYS

Your insurance will not cover your copay that is required for each visit.  Payment of copays are due at time of service.

OUT OF NETWORK

If we are out of network for your insurance, it’s possible you can contact your insurance and ask for a single case agreement for TMS treatment. Otherwise, it will be considered out of network and coverage is likely minimal to no coverage at all. If a single case agreement is approved,  you will still need to meet the criteria for TMS treatment.

TREATMENT WITHOUT INSURANCE

If you choose to pay for TMS treatment out of pocket via cash or credit card you will pay the full treatment price of each visit.  We do not offer sliding scale or discounted fees.

INSURANCE TMS NW ACCEPTS