Is TMS Therapy Covered by Insurance?

For people living with depression that hasn’t responded to medication or therapy, Transcranial Magnetic Stimulation (TMS) therapy is becoming an increasingly recognized treatment option. As awareness grows, so does a common question: Does insurance cover Transcranial Magnetic Stimulation (TMS) therapy?

Understanding insurance coverage for TMS involves navigating clinical guidelines, eligibility requirements, and new developments in the field, including a recent FDA breakthrough that extends TMS access to adolescents aged 15 and older. This blog explores what TMS therapy is, how insurance coverage works, and what patients—both teens and adults—can expect in 2025.

What Is TMS Therapy?

Transcranial Magnetic Stimulation (TMS) is a non-invasive, medication-free treatment that uses magnetic pulses to activate specific brain regions involved in mood regulation. It is FDA-approved for the treatment of Major Depressive Disorder (MDD) and for individuals who haven’t improved with antidepressant medications or psychotherapy.

TMS is typically administered in a psychiatrist’s office five days a week for 6 to 8 weeks. Each session lasts about 20 minutes. Unlike treatments that require sedation or medication adjustments, TMS allows patients to resume daily activities immediately after each session.

This therapy is often used when other approaches have failed, which makes insurance coverage especially important for those already burdened by the emotional and financial weight of chronic depression.

Is TMS Therapy Covered by Insurance?

In most cases, yes—TMS therapy is covered by insurance when specific medical criteria are met. 

Major insurers that routinely include TMS as a covered treatment for Major Depressive Disorder include but are not limited to: 

• Blue Cross Blue Shield

• Aetna

• Cigna

• UnitedHealthcare

• Medicare 

  
  

Most insurance plans require the following conditions:

• A confirmed diagnosis of Major Depressive Disorder

• Documented treatment resistance to at least two antidepressant medications

• Participation in evidence-based psychotherapy

• A formal evaluation recommending TMS therapy by a licensed provider

While exact coverage and costs may vary by plan, preauthorization is typically required, and documentation of prior treatment attempts is essential for accurate reimbursement. Out-of-pocket expenses such as co-pays or coinsurance may still apply, depending on your plan.

What If Insurance Doesn’t Cover It?

Although most plans include TMS under certain conditions, coverage is not universal. Patients who don’t meet insurer criteria may face out-of-pocket costs ranging from $8,000 to $10,000 for a full course of treatment. These costs often reflect the number of sessions and provider rates.

In some cases, insurance plans may initially deny coverage for TMS, even when a patient meets the medical criteria. Appeals and peer-to-peer reviews with psychiatrists are sometimes necessary to gain approval.

At Advanced Psychiatry, we will look into your insurance coverage and help you understand your financial options. We will ensure that alternative treatment options, such as TMS, are accessible to you. It’s always worth consulting directly with your provider to understand financial options.

New FDA Approval for Adolescents Aged 15 and Older

A significant development in the field of mental health treatment came recently when the FDA approved TMS therapy for adolescents aged 15 and older—marking a breakthrough in how teen depression may be addressed moving forward.

This expansion is especially significant as depression rates among teens have risen, and many young people experience side effects or limited success with traditional antidepressants. While research continues to evolve, this approval opens new possibilities for non-medication-based treatment in adolescent populations.

Insurance coverage for teens is still limited and largely determined on a case-by-case basis. Some insurers are beginning to approve TMS for adolescents who meet the standard medical criteria, but formal coverage policies may lag behind FDA approvals.

If you are interested in TMS for teens here at Advanced Psychiatry, we encourage you to consult both us and your insurance provider to explore eligibility.

Navigating the Path to TMS

If you’re exploring TMS therapy, understanding insurance coverage is a critical first step. The treatment has become more accessible in recent years thanks to expanded insurance inclusion and growing clinical validation. With the new FDA approval for teens, more patients may soon be eligible for this intervention.

At Advanced Psychiatry, we stay current on coverage trends and collaborate with patients, families, and insurers to help remove barriers to care. If you’re ready to explore whether TMS is right for you or have questions, let’s get connected and have that conversation.

Advanced Psychiatry provides authentic and trusted treatment options to those in the Fort Wayne, Ann Arbor, Lansing, and Troy communities. Learn more about TMS therapy and insurance by contacting our team.