Does my insurance cover TMS?

Most major insurers cover TMS for major depressive disorder when medical necessity criteria are met. Florida TMS Clinic verifies your benefits and manages pre-authorization on your behalf.

How many medications do I need to try before TMS?

It varies by insurer. Medicare often requires at least one trial; most commercial plans require two; Humana may require four. We review your record and document adequate dose and duration.

Is retreatment covered if symptoms return?

Yes, many plans cover retreatment with documentation of prior improvement and relapse. Some specify minimum intervals (for example 60–180 days).

What if I could not tolerate antidepressants?

Intolerable side effects can count as failed trials with every insurer in this guide. Make sure the side effects and dates are documented.

How long is a standard TMS course?

Most insurers cover about 30 sessions over 6 weeks plus a small taper. Your exact schedule is individualized by our psychiatrist.

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Why this matters

Most major insurers cover TMS — with specific criteria

TMS is an FDA-cleared, noninvasive treatment for major depressive disorder (MDD). Insurers approve it when medical necessity is documented. At Florida TMS Clinic, we manage the entire authorization process for you — from verifying benefits to submitting prior-auth with the right clinical details.

What insurers look for

Diagnosis: MDD (single or recurrent), often severe or treatment-resistant.
Medication trials: Most plans require at least two adequate trials; Medicare may accept one; Humana may require four.
Objective scales: We collect baseline and follow-up scores (PHQ-9, HAM-D, MADRS).
Intolerance counts: Significant side effects can qualify as “failed.”

Our clinicians document dose, duration, efficacy, and side effects for a clean submission and quicker approvals.

Coverage, by insurer

Medicare

Diagnosis: Severe MDD
Medication trials: ≥ 1
Scales: Typically documented; psychiatrist order required
Retreatment: Covered with documented relapse

Florida Blue

Diagnosis: Severe MDD (no psychosis), 15–70y
Medication trials: ≥ 2 (or intolerances)
Scales: Baseline, every 2 weeks, end of treatment
Retreatment: ≥ 90 days after prior course

UnitedHealthcare

Diagnosis: MDD (≥18y)
Medication trials: ≥ 2 (2 classes)
Scales: Baseline required
Retreatment: ≥ 180 days after prior course with ≥ 50% prior improvement

Cigna

Diagnosis: Moderate–Severe MDD (adults & adolescents)
Medication trials: ≥ 2 (≥ 4 weeks each)
Scales: Validated tools required
Retreatment: Case-by-case with documentation

Aetna

Diagnosis: Severe MDD (no psychosis), ≥15y
Medication trials: ≥ 2 (≥ 2 classes)
Augmentation: Required (e.g., lithium or atypical antipsychotic)
Scales: Baseline + during course
Retreatment: ≥ 60 days after ≥ 50% prior response + relapse

Humana

Diagnosis: MDD (DSM-5)
Medication trials: ≥ 4 (or intolerances)
Scales: PHQ-9 used for retreatment criteria
Retreatment: Prior ≥ 50% improvement then ≥ 50% worsening

TRICARE

Diagnosis: Severe MDD (≥18y)
Medication trials: ≥ 2 (or intolerances)
Scales: BDI, HAM-D, MADRS or PHQ-9
Retreatment: Covered with documented relapse

At-a-Glance Comparison

Insurer	Diagnosis Covered	Min. Med Trials	Augmentation Required	Severity / Scales	Retreatment	Min. Wait	Session / Taper	Notes
Medicare	Severe MDD	1	No	Severe; scales typically documented	Yes (relapse)	—	~6 weeks	Psychiatrist order required
Florida Blue	Severe MDD (no psychosis), 15–70y	2	No	Baseline + q2w + final	Yes	≥90 days	6w + 3-2-1 taper	Document SUD stability
UnitedHealthcare	MDD (≥18y)	2 (2 classes)	No	Baseline scale required	Yes if ≥50% prior response	≥180 days	30 + 6 taper	Accelerated/TBS unproven
Cigna	Mod–Severe MDD (adult/adolescent)	2 (≥4w each)	No	Validated scales	Case-by-case	—	—	Adolescents included
Aetna	Severe MDD (no psychosis), ≥15y	2 (≥2 classes)	Yes	Baseline + during course	Yes if ≥50% prior response	≥60 days	30 + 6 taper (36 max)	Accelerated/navigated/maintenance unproven
Humana	MDD (DSM-5)	4 (or intolerances)	No	PHQ-9 for retreatment	Yes; ≥50% prior response then ≥50% worsening	—	—	Maintenance not covered
TRICARE	Severe MDD (≥18y)	2 (or intolerances)	No	BDI/HAM-D/MADRS/PHQ-9	Yes (relapse)	—	5d/w for 4–6w	Pre-auth required

Policies evolve; our team verifies current benefits before treatment.

Frequently Asked Questions

Is TMS covered for anxiety or OCD?

For anxiety symptoms within MDD, yes—if billed under the MDD indication. OCD coverage varies by plan; many consider it investigational. We’ll verify your benefits and explain options.

Do intolerable side effects count as failures?

Yes. If you stopped medications due to significant side effects, insurers typically count those as failed trials when properly documented.

How soon can I get retreatment?

Examples: Aetna ≥60 days, Florida Blue ≥90 days, UnitedHealthcare ≥180 days after the last course with prior response.

How long does a standard course take?

Most standard courses include ~30 sessions over 6 weeks, followed by a short taper. You’re awake the whole time—no anesthesia—and there’s no downtime.

Start your coverage check

Our insurance specialists verify benefits for you and provide a clear estimate of out-of-pocket costs before treatment begins.

📞 Call (813) 867-2378 📅 Request a coverage check

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