TMS Now Covered by Medi-Cal

Great News for Our Patients!

We are delighted to share that after months of diligent effort, Medi-Cal has approved coverage for TMS (Transcranial Magnetic Stimulation) treatment. This milestone means that many of our patients with Medi-Cal insurance can now access this transformative therapy.
We’re excited about the positive impact this will have on our community’s health and well-being. Thank you for being a part of our journey!

Medicaid and Medi-Cal Insurance Coverage for TMS in California

Starting August 1, 2024, California’s Medicaid program, Medi-Cal, along with CalOptima in Orange County, began covering transcranial magnetic stimulation (TMS) therapy for adults with major depressive disorder (MDD). This policy change marks a significant step forward in improving access to mental health care, providing new hope for individuals who have struggled to find effective treatment.

TMS therapy is a non-invasive, FDA-approved treatment for depression that uses magnetic fields to stimulate brain regions involved in mood regulation. Unlike traditional therapies, TMS does not require sedation or anesthesia, making it a safer and more tolerable option for many. Treatment typically consists of daily sessions over several weeks, with each session lasting about 30 minutes.

A major benefit of TMS therapy is its precision. The magnetic pulses can be carefully directed to specific areas of the brain associated with mood disorders, resulting in more effective and efficient treatment. This targeted approach is especially valuable for individuals with MDD who have not experienced relief from antidepressants or other therapies.

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Understanding Your Medi-Cal or Medicaid Insurance Coverage

Medi-Cal has recently expanded its coverage to include transcranial magnetic stimulation (TMS) therapy under specific conditions, broadening access to this innovative treatment. The coverage encompasses the following CPT codes:

• 90867: This code applies to the initial session of TMS therapy, which includes cortical mapping, determining the motor threshold, delivery of the treatment, and overall management. This foundational session is essential for customizing the therapy to suit the patient’s unique needs.
• 90868: This code covers subsequent TMS therapy sessions, addressing the delivery and management of the treatment after the initial setup. Each follow-up session is billed under this code.
• 90869: This code is designated for maintenance sessions, which may be needed to prolong the positive effects of TMS therapy over time.

It’s important to understand that this coverage is available for adults diagnosed with major depressive disorder (MDD) who meet Medi-Cal’s eligibility criteria. By including these CPT codes, Medi-Cal highlights the importance of TMS therapy as an alternative to traditional medication-based treatments.

Medicare also offers coverage for TMS therapy, but its availability depends on specific conditions. Typically, Medicare covers TMS for individuals with treatment-resistant depression who have not achieved satisfactory results with antidepressants or other therapies. To qualify, patients must meet Medicare’s medical necessity requirements, and the therapy must be administered by an approved provider. Patients should consult with their healthcare provider and review their Medicare plan to fully understand their TMS therapy coverage.

Benefits of TMS

TMS therapy provides a variety of advantages, making it a highly attractive option for individuals looking for alternatives to traditional medication:

• Non-Invasive: TMS is a non-invasive procedure that eliminates the need for surgery or anesthesia, minimizing risks and allowing patients to resume their regular activities immediately after each session.
• Medication-Free: For those who wish to avoid medication or have not responded well to it, TMS offers a non-drug solution that can significantly alleviate depressive symptoms.
• Few Side Effects: TMS typically has very few side effects. Some individuals may experience mild headaches or scalp discomfort, but these issues are temporary and tend to resolve quickly.
• Targeted Approach: TMS delivers magnetic stimulation to specific regions of the brain linked to mood regulation, making it an efficient and focused treatment for major depressive disorder.
• Durable Results: Studies show that many patients experience long-term symptom improvement, with positive effects lasting several months or more after completing the therapy.

The inclusion of TMS therapy in Medi-Cal’s coverage represents a major advancement in the treatment of depression in California. Previously, the high cost of TMS—ranging from $300 to $600 per session for uninsured individuals—was a barrier for many. By covering TMS, Medi-Cal has made this innovative treatment accessible to a wider population, reducing financial obstacles and broadening access to mental health care.

At A Better Way Psychiatry and TMS Clinic, our mission is to support adults across California in achieving their mental health goals. If you or someone you know is dealing with major depressive disorder and considering TMS therapy, we invite you to contact us. Our dedicated team is ready to provide guidance, answer your questions, and help you determine if TMS is the right treatment for you.

Get in touch today to schedule a free consultation and take the first step towards a healthier, more fulfilling life. We proudly serve communities throughout California, and our clinics are currently accepting new patients!

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