Insurance Coverage for NeuroStar TMS Therapy in Santa Monica

Transcranial magnetic stimulation, or TMS therapy, is a non-invasive form of brain stimulation designed to relieve symptoms associated with certain types of psychiatric conditions. TMS therapy involves using magnetic pulses to stimulate neuronal activity in regions of the brain associated with mood regulation. TMS is especially effective for treating people with major depressive disorder when they do not respond to medication therapy. Studies have shown that after receiving a full course of NeuroStar Advanced Therapy, a significant number of patients experience noticeable relief from psychiatric symptoms or complete remission (Sackeim HA, et al., 2020, J Affect Disord, 277:65-74). This conclusion is based on a real-world, retrospective study using CGI-S with a sample size of 615 patients.

Because of the effectiveness of TMS in treating some cases of depression, more insurance companies are covering the costs related to TMS therapy. While major insurance companies have begun to cover the costs of TMS therapy, there are important factors to consider when determining if you have insurance coverage for NeuroStar TMS therapy in Santa Monica.

Which Insurance Companies Offer Coverage For TMS Therapy?

While several insurance companies offer coverage for TMS therapy, the exact requirements and eligibility criteria for this coverage may vary per insurance provider. It is, therefore, essential to verify eligibility criteria and requirements before beginning a course of TMS therapy. For example, some insurance companies may require documentation that you have attempted first-line therapies, such as a full course of antidepressants, prior to approving your coverage for TMS therapy.

The major insurance companies that provide insurance coverage for Santa Monica NeuroStar TMS therapy include:

• Aetna
• Cigna
• Magellan Health
• UnitedHealthcare
• Anthem Blue Cross
• L.A. Care Health Plan
• Blue Shield of California

In addition to these private insurance companies, Medicare and MediCal also provide insurance coverage for NeuroStar TMS Therapy to treat treatment-resistant major depressive disorder. 

Why Might My Insurance Company Deny NeuroStar Advanced TMS Therapy?

While most major insurance companies cover the costs of TMS Therapy for treatment-resistant MDD, some smaller insurance companies may not yet provide coverage. 

It is also possible that your insurance company does not cover TMS therapy for your particular condition. For example, your insurance company may cover TMS therapy for major depressive disorder but not for anxious depression or obsessive-compulsive disorder. It is always a good idea to speak with your insurance coverage first before undergoing NeuroStar TMS therapy.

Insurance companies may also deny coverage to individuals if they do not meet the eligibility requirements. Eligibility requirements may include an official diagnosis from a physician, along with proof that you have attempted at least two courses of antidepressants with no meaningful symptom relief.

Contraindications

In addition to not meeting the eligibility criteria for insurance coverage for TMS therapy, you may also be denied coverage if you have any contraindications to receiving TMS therapy. Requirements for proof of diagnosis and contraindications for coverage may vary among insurance providers, so it is important to work closely with our office.

Additional Reasons

Your eligibility for TMS therapy will also depend on your age and past medical history. Your insurance may deny coverage if you: 

• Are under 18 years of age
• Have seizure disorders or any history of seizures
• Have acute or chronic psychotic symptoms or disorders (such as schizophrenia, schizophreniform, or schizoaffective disorder)
• Have epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, history of repetitive or severe head trauma, or primary or secondary tumors in the central nervous system
• Have magnetic-sensitive medical device implants that are placed near the location of the TMS magnetic coil

Our team in Santa Monica could help you navigate insurance coverage for NeuroStar TMS therapy. 

Find Out if Your Insurance Will Cover NeuroStar TMS Therapy in Santa Monica – Consult Our Team Today

NeuroStar TMS therapy is covered by most insurance companies, including Medicare and MediCal. It is important, however, to ensure you understand the eligibility criteria and all requirements of your particular insurance company to ensure your TMS therapy will be covered. If you are suffering from a mental disorder that can be treated with TMS therapy, do not let the costs of therapy stand in your way. Learn more about insurance coverage for NeuroStar TMS therapy in Santa Monica – meet with our team today.

Adult Indications for Use

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 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).

Visit neurostar.com for full safety and prescribing information.

Important Safety Information

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).

NeuroStar Advanced Therapy should not be used with patients who have non-removable conductive metal in or near the head. NeuroStar Advanced Therapy has not been studied in patients who have not received prior antidepressant treatment.