Medicare coverage for TMS therapy
We work with Medicare plans for TMS therapy, Spravato, medication management, and psychotherapy. We verify your specific coverage within one business day — before you commit.
Medicare coverage details
Medicare Part B covers outpatient psychiatric care for beneficiaries, including evaluation and management visits, medication management, and Transcranial Magnetic Stimulation for treatment-resistant depression. CMS issued a National Coverage Determination (NCD 160.27) for TMS on December 26, 2024, establishing nationwide Medicare coverage for FDA-cleared TMS devices used to treat major depressive disorder in adults who meet defined criteria. This NCD supersedes the prior patchwork of regional Medicare Administrative Contractor (MAC) policies and creates a consistent federal coverage floor that Medicare Advantage plans must also meet at minimum.
What Medicare typically covers
- Adult psychiatry and medication management — evaluations, follow-ups, prescription oversight under Part B
- TMS therapy for FDA-cleared indications — MDD/treatment-resistant depression per NCD 160.27; OCD coverage at MAC discretion as of this writing
- Outpatient psychotherapy — individual sessions with Medicare-enrolled providers
Coverage detail differs between Original Medicare (Parts A and B) and Medicare Advantage (Part C). Advantage plans set their own networks, copays, and prior-authorization workflows but must cover at least what Original Medicare covers under the NCD.
Prior authorization for TMS
Original Medicare does not require prior authorization for most outpatient psychiatric services, but TMS is a higher-utilization specialty procedure and may require coverage determination documentation per the NCD. Medicare Advantage plans generally do require prior authorization. Documentation typically required:
- Confirmed DSM-5 diagnosis of severe major depressive disorder, single or recurrent episode
- Documented failure of at least four antidepressant trials (the Medicare bar is stricter than most commercial carriers' two-trial requirement), or documented intolerance to medication
- Baseline severity score (PHQ-9, HAM-D, or equivalent)
- Documented psychotherapy trial
- Treatment delivered by an FDA-cleared TMS device
Healing TMS Clinic uses FDA-cleared TMS devices and meets the credentialing requirements set out in NCD 160.27.
Verifying your specific plan
Original Medicare beneficiaries should also check Medigap (supplemental) coverage for Part B coinsurance. Medicare Advantage members should verify the specific plan's TMS policy, since Advantage plans implement the NCD with their own networks and authorization rules. Verify against your Medicare card or Advantage plan ID before scheduling.
Verify Your Coverage
Not sure if your plan covers TMS at Healing TMS Clinic?
Send us your insurance card and date of birth via our secure verification form. Our team responds within 1 business day with the exact coverage, prior-authorization requirements, and your estimated out-of-pocket cost.
Other services covered
About Healing TMS Clinic
Healing TMS Clinic is a psychiatric outpatient practice at 5475 East La Palma Avenue, Suite 204, Anaheim, CA 92807. We serve patients throughout Orange County, North Long Beach, the San Gabriel Valley, and the Inland Empire within a 30-mile radius. Call (657) 656-5611 to begin verification or to schedule a clinical consultation.
Other carriers we work with
Find out if TMS is covered for you.
Insurance verification takes about two minutes. We'll tell you whether your plan covers TMS for treatment-resistant depression and what your cost will be — before you book anything.
Monday–Friday, 9:00 AM – 5:00 PM