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Athena Care
Does Blue Cross Blue Shield Cover TMS Therapy?

Does Blue Cross Blue Shield Cover TMS Therapy?

Does Blue Cross Blue Shield Cover Transcranial Magnetic Stimulation (TMS)?

Transcranial Magnetic Stimulation (TMS) may be covered by Blue Cross Blue Shield (BCBS) of Tennessee if TMS therapy is medically essential and the patient meets all required criteria.1 Your Blue Cross Blue Shield TMS coverage details will depend on your particular benefit plan.

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How to Verify TMS Therapy Blue Cross Blue Shield Coverage

Athena Care, a TMS clinic in Tennessee, is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the best method to determine if your Blue Cross Blue Shield insurance covers TMS.

Let our highly experienced, expert care coordinators handle the challenges of contacting your insurance carrier for more information about Blue Cross Blue Shield transcranial magnetic stimulation coverage. A care coordinator will review your policy and clearly explain your options after you’ve completed the form. Rest assured, all submitted or discussed information is kept confidential.

BCBS TMS Coverage Eligibility Policy

Blue Cross Blue Shield TMS coverage is considered medically necessary when the patient meets ALL of the following medically appropriate conditions:

  • 18 years of age or older
  • Confirmed diagnosis of severe major depressive disorder (MDD) (first or subsequent episodes) as determined by a standardized-rating scale that accurately evaluates depressive symptoms.
  • Failure of a psychotherapy trial

ANY OF THE FOLLOWING MUST BE RECORDED:

  • Four trials of psychopharmacologic drugs for depression failed, involving two different agent classes. At least one of the treatment trials had to be provided as an adequate mono- or poly-drug therapy course.
  • Four trials of psychopharmacologic drugs with documented adverse effects show an inability to tolerate a significant therapy dose.
  • Response to TMS in the past during a depressive episode
  • Individual qualifies for electroconvulsive treatment (ECT) not clinically superior to TMS.

ALL OF THE FOLLOWING ARE MISSING:

  • Pregnancy
  • Ongoing substance abuse
  • In the current depressive episode, the presence of acute or chronic psychotic symptoms/disorders, such as schizophrenia
  • Epilepsy, history of seizure disorder with an increased risk of future seizures, cerebrovascular illness, dementia, elevated intracranial pressure, history of recurrent or severe head trauma, and primary or secondary central nervous system malignancies are all examples of neurologic disorders.
  • Cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, and gunshot fragments are examples of magnetic-sensitive medical devices placed 30 cm or fewer from the TMS magnetic coil.

Furthermore, any device used in this treatment must be FDA approved for the specific indication.

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for delivering electrical stimulation to the brain in patients with treatment resistant depression (TRD) and other psychiatric and neurologic illnesses.

The procedure entails placing a tiny coil on the scalp and passing a quickly alternating current via the coil wire. The electrical current creates a magnetic field that penetrates the scalp and bone without obstructing, stimulating neural activation.  

TMS therapy treatment will not be available to people with specific medical implants. When metal implants or gadgets interact with magnetic fields, they might cause issues. In addition, you may not be eligible for TMS therapy if you have stents, implanted stimulators, a pacemaker, a medicine pump, cochlear implants, or gunshot fragments in your body. It’s critical to discuss these concerns with your doctor before TMS therapy to avoid any consequences.

TMS is also not suggested for persons who have specific medical conditions. For example, those with a history of seizures or who suffer from bipolar illness should avoid TMS therapy. It is also not advised for pregnant women.

Finally, inform your TMS doctor about any prescription or over-the-counter medications, supplements, or vitamins you’re taking. Depending on anything you’re regularly taking, they’ll need to ensure that TMS therapy is safe for you.

How Much Does TMS Cost Without Insurance?

The following are average costs for TMS therapy without insurance, though these costs may vary by location and other factors. Furthermore, they may not reflect the actual cost of treatment or what you may pay in Tennessee.

TMS therapy sessions typically cost between $400 and $500 per session.2 Because most people require multiple TMS therapy sessions to achieve optimal outcomes, the total cost of TMS therapy could be about $15,000.

Sources

  1. “Transcranial Magnetic Stimulation (TMS).” BlueCross BlueShield of Tennessee Medical Policy Manual, BlueCross BlueShield of Tennessee, Inc, 21 Dec. 2016, www.bcbst.com/mpmanual/Transcranial_Magnetic_Stimulation_TMS.htm
  2. Porter, Robert. “What Does TMS Therapy Cost? TMS Information | BetterHelp Advice.” Betterhelp, BetterHelp, 20 Apr. 2022, www.betterhelp.com/advice/therapy/how-much-does-tms-therapy-cost

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155