How to Determine The Out-of-Pocket Cost of Transcranial Magnetic Stimulation (TMS)

Nov 25, 2022
Determining the cost of TMS is complicated
Out-of-pocket costs for TMS vary widely. Many factors are considered when making this determination. For example, the cost depends on whether your insurance covers this procedure and on how many treatments are deemed necessary for your recovery.

Since becoming approved by the FDA in 2008, Transcranial Magnetic Stimulation (TMS) has become increasingly popular as a treatment for mood disorders ranging from major depression to Obsessive-Compulsive Disorder (OCD). The high rates of effectiveness, non-invasive approach, and paucity of side effects of TMS make it a very appealing option for many doctors and patients. Yet the question that still remains on many patients’ minds is: how much will a course of TMS cost for me?

The answer – as is often the case with all things that involve medical insurance – is: it depends. 


Does My Health Insurance Cover TMS?

Without doubt, over the past several years, more and more health insurance plans have begun to cover TMS. Still, the out-of-pocket cost of TMS can vary widely. The best way to determine your particular out-of-pocket cost is to receive a psychiatric assessment by a TMS specialist, followed by a benefits investigation by their insurance experts. Dr. Elia Gonzalez-Rodriguez and her team at Pacific Phoenix TMS have extensive experience making these determinations.

At Pacific Phoenix TMS we welcome the following health insurance plans: 

  • Blue Cross Blue Shield
  • Tricare
  • Aetna
  • ComPsych
  • Cigna
  • First Choice
  • Pacific Source
  • MHN
  • United Healthcare / UMR / Optum
  • Premera
  • Anthem
  • Providence


How Much Will A Course of TMS Cost Me?

Despite the many steps involved in determining the cost of treatment, it can be helpful for patients to gain a better understanding of the process that goes into that process. The cost is basically driven by two factors: your individual medical history and the terms of your specific insurance plan.

On the medical front, considerations include:

  • your age
  • the severity of your mood disorder
  • the number of alternative treatments that have failed to produce results
  • other factors

On the insurance front, many factors are at play as well – assuming that your plan does cover TMS. They include:

  • in-network vs. out-of-network status
  • size of your remaining annual deductible
  • amount/frequency of the copays or coinsurance charged by your plan
  • size of your out-of-pocket maximum
  • other factors

Depending on your out-of-pocket cost, payment plans may also be available through our clinic, or can be arranged through AdvanceCare or CareCredit.


How Can I Find Out if My Insurance Covers TMS?

If you wish to find out firsthand if TMS is covered, you can call the Member Services number on the back of your insurance card. You will want to make sure the following TMS CPT codes are covered: 90867, 90868, and 90869.


What if My Insurance Does Not Cover TMS? What if I Don't Have Medical Insurance Coverage?

  • It is not unusual for insurance to deny the first round of requests to approve TMS treatment. Our office has an excellent track record of handling denials and filing successful appeals on our patients’ behalf.
  • If your insurance plan does not cover TMS, or if you don't have medical insurance, you can still receive TMS treatment by paying “out of pocket”. 
  • Your cost will depend on the details of your treatment, such as the number of sessions required. 
  • Payment plans may also be available through our clinic, or can be arranged through AdvanceCare or CareCredit.

If you are suffering from depression, OCD, or PTSD, don’t wait – contact Pacific Phoenix TMS today and take an important step on the road to recovery!