Taking the First Step Without Breaking the Bank
If you’ve been struggling with depression and finally found out about Transcranial Magnetic Stimulation (TMS), you might be wondering:
Is TMS therapy covered by insurance?
And if it is… how do I find out what’s included and what I’ll pay out of pocket?
The good news is that TMS is FDA-approved and covered by most major insurance plans—including Medicare, many Medicaid programs, and private insurance companies. But the process can feel confusing, especially when you’re already dealing with mental health challenges.
That’s why at Bella Vida TMS, we walk every patient through it—step by step. In this guide, we’ll help you understand what to expect, what to ask your insurer, and how to get approved for the care you need.
Is TMS Covered by Insurance?
In most cases, yes. TMS is covered by:
- Medicare
- Most commercial insurance (like Aetna, Cigna, Blue Cross Blue Shield, United Healthcare, etc.)
- Some Medicaid plans (coverage varies by state)
TMS is recognized as medically necessary for treatment-resistant depression—which means it’s not just experimental or elective.
To qualify for insurance coverage, most plans require that you:
✅ Have a diagnosis of major depressive disorder
✅ Have tried 2+ antidepressants without success
✅ May have tried psychotherapy or other treatments
✅ Are not currently experiencing seizure risk or other contraindications
If you meet those criteria, you likely qualify.
- Blue Cross Blue Shield of Arizona (BCBSAZ)
- Aetna
- Banner – University Family Care (AHCCCS & Medicare)
- Arizona Complete Health (AHCCCS)
- Care1st Health Plan Arizona (AHCCCS)
- Health Choice Arizona (AHCCCS)
- Medicare Advantage
- Medicare (Traditional)
- SCAN Health Plan
- Blue Advantage (BCBSAZ Medicare)
- Veterans Affairs (VA)
What Will Insurance Actually Cover?
Most insurance plans will cover:
- The full TMS treatment course (typically 5 sessions per week for 6 weeks, then tapering)
- Initial psychiatric evaluation
- Follow-up sessions or reassessments
- Continuation or maintenance therapy, depending on your plan
You may still be responsible for:
- Deductibles
- Co-pays or coinsurance
- Out-of-network fees, if applicable
💡 At Bella Vida TMS, we verify your benefits for free and give you a full breakdown of costs before you start.
How Do I Check if My Insurance Covers TMS?
Here are the steps to confirm TMS coverage with your insurance provider:
1. Call the Member Services Number
It’s usually on the back of your insurance card. Ask to speak with someone about behavioral health services or pre-authorization for TMS therapy.
2. Have Your Diagnosis Ready
Let them know you’ve been diagnosed with major depressive disorder and that you’re considering TMS after trying two or more antidepressants.
3. Ask the Right Questions:
- “Does my plan cover TMS therapy for depression?”
- “What are the criteria to qualify?”
- “Do I need a referral or prior authorization?”
- “What are my co-pays, deductibles, or coinsurance?”
- “Is Bella Vida TMS an in-network provider?”
Or, skip all this—and let us do the work for you.
What If My Plan Requires Prior Authorization?
Many insurance plans do. Prior authorization means your doctor or TMS clinic will submit medical records proving that you’ve:
- Tried at least 2 antidepressants
- Tried talk therapy
- Still have symptoms of moderate to severe depression
We handle this paperwork at Bella Vida TMS so you don’t have to worry about it.
What If I Have a High Deductible?
Even if your plan covers TMS, you may still have out-of-pocket costs—especially if you haven’t met your annual deductible yet.
You can ask:
- “How much of my deductible have I met this year?”
- “What would my estimated out-of-pocket cost be for TMS?”
We can help you understand this and provide payment plan options if needed.
What If My Insurance Says No?
Sometimes, insurance plans deny TMS coverage at first. This doesn’t mean the end of the road.
You can:
- File an appeal with help from our office
- Submit additional documentation from your psychiatrist
- Consider Spravato®, another covered treatment option we offer
- Explore TMS trials or payment plans
We’re here to support you and fight for your care.
Modern care. Proven results. Covered by insurance.
TMS therapy is a powerful treatment option for people living with depression—and in most cases, insurance will help pay for it. The key is knowing what to ask, working with a supportive provider, and having an advocate in your corner.
At Bella Vida TMS, we do all of this for you. From free insurance verification to helping you understand your benefits, we make the process smooth so you can focus on what really matters—feeling better.
References
- Centers for Medicare & Medicaid Services (CMS) – National Coverage Determination (NCD) for Transcranial Magnetic Stimulation (TMS) Therapy
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=374 - Blue Cross Blue Shield Association – Coverage Policy for TMS Therapy
https://www.bcbs.com - American Psychiatric Association – TMS Treatment Guidelines and Clinical Use
https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines - National Institute of Mental Health (NIMH) – Depression Treatment Overview
https://www.nimh.nih.gov/health/topics/depression - Mayo Clinic – Transcranial Magnetic Stimulation (TMS) for Depression: What to Expect
https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625 - American Medical Association (AMA) – Coding and Billing Guidelines for TMS Therapy
https://www.ama-assn.org
