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Transcranial magnetic stimulation (TMS) is an FDA-cleared treatment for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and MDD with anxiety. If you are exploring this option, you might find it helpful to know about insurance coverage for NeuroStar Advanced TMS Therapy; contact our Albany team in the Capital District for more information about your eligibility.
Is NeuroStar TMS Therapy Covered by Insurance?
Most insurance plans in the United States fully or partially cover TMS therapy for eligible adult patients in Albany. While the specific requirements for your insurance carrier may vary, most policies include these requirements:
- You have been diagnosed with major depressive disorder (MDD), obsessive-compulsive disorder (OCD), or MDD with comorbid anxiety
- Your depression has not been relieved by at least two antidepressant medications; some carriers require up to four failed antidepressant trials
- Your OCD has not been relieved by at least two medications and psychotherapy has not worked
- You are not pregnant or breastfeeding
U.S. health insurance companies that offer partial or complete coverage for TMS therapy include Aetna, Anthem, BlueCross/BlueShield, Optum, Humana, Kaiser Permanente, Fidelis, Medicare, Meritain, Cigna, Tricare, and United Healthcare.
Since coverage and reimbursement vary depending on individual policies and guidelines, please contact your insurance provider directly to determine your coverage and eligibility for TMS treatments.
Some plans require patients to have prior authorization before they will cover TMS; and all the patient’s relevant healthcare providers must provide records supporting treatment before the patient can begin TMS. These steps are critical because the medical coding used for TMS therapy must accurately reflect the nature of the treatment and diagnosis for insurance to reimburse it.
Our team can help you determine your insurance coverage for NeuroStar TMS therapy.
How To Improve the Odds of Coverage
There are many ways to improve your chances that insurance will cover NeuroStar TMS therapy at our clinic.
Review your policy and contact your insurance provider to understand what criteria must be met for coverage. Some carriers require minimums on how long you have stayed with other treatment approaches, including medication trials.
Always keep accurate records and documentation of your prior and current mental healthcare to show the degree to which any treatments have contributed to your progress. Document conversations, keep copies of letters, and note the dates and times of any phone conversations with providers. This information is essential to ensure the medical necessity of TMS therapy is well-documented. It may also be valuable if you need to appeal a denial of coverage.
What Happens if TMS Is Not Covered?
TMS therapy is also available via a cash-pay option. We are willing to discuss spreading payment for treatment over several months, up to one year depending on individual financial circumstances.
Ask About Insurance Coverage for NeuroStar TMS Therapy in Albany
There is financial relief available when you want to treat your major depressive disorder (MDD), obsessive-compulsive disorder (OCD), or anxious depression with TMS therapy: Insurance coverage for NeuroStar TMS Therapy is available in Albany. While TMS is safe and highly effective, a course of treatment can be expensive. You want to make sure you have a plan so you can concentrate on your mental health without worrying about the cost of treatment.
Our Capital District team is happy to answer any questions you might have. For more information, or to schedule a consultation, reach out to our clinic today.
Adult Indications for Use
The NeuroStar Advanced Therapy System is indicated for the treatment of depressive episodes and for decreasing anxiety symptoms for those who may exhibit comorbid anxiety symptoms in adult patients suffering from Major Depressive Disorder (MDD) and who failed to achieve satisfactory improvement from previous antidepressant medication treatment in the current episode.
The NeuroStar Advanced Therapy System is intended to be used as an adjunct for the treatment of adult patients suffering from Obsessive Compulsive Disorder (OCD).
Adolescent Indications for Use
NeuroStar Advanced Therapy is indicated as an adjunct for the treatment of Major Depressive Disorder (MDD) in adolescent patients (15-21).
Important Safety Information
NeuroStar Advanced Therapy is only available by prescription. A doctor can help decide if NeuroStar Advanced Therapy is right for you. Patients’ results may vary.
The most common side effect is pain or discomfort at or near the treatment site. These events are transient; they occur during the TMS treatment course and do not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of TMS therapy (<0.1% per patient).
Visit neurostar.com for full safety and prescribing information.
