The Cost of TMS Therapy

The cost of TMS therapy

Zip Code Based Results

So you are considering TMS Therapy for yourself or your loved one and wondering about the cost of TMS. You came to the right place. The average cost of TMS therapy is about $300 per session. The total cost of TMS treatment course can range between $6,000 to $12,000. Your insurance will cover most of this cost.

In this article I will tell you how you can find out the average cost of TMS therapy in your particular zip code. Follow the following 4 steps and you will get your exact answered.

Go to https://www.fairhealthconsumer.org/ and click on "Search for Medical and Hospital Costs"

Choose whether you want to see the rate for in-network, out-of-network or both. If you want to see both just click "Not Sure"

Choose your zip code. In the example we entered Florida TMS Clinic zip code which is 33544.

Enter the CPT code: 90868

Transcranial magnetic stimulation treatment (stimulates nerve cells in brain to improve symptoms of depression), subsequent delivery and management, per session

Click on "Get your cost"

Get your TMS cost per session

The next page will show your TMS cost per session. You will see "in-network price" and "out-of-network price"

Now that you know the answer, if you are still interested in reading more about the cost of TMS therapy then please be my guest. We will walk you through the cost of depression, the cost of antidepressants, and the cost of TMS therapy in details. You will see the references for where the data is coming from. Please note that this article was last updated in January 2021. Obviously, the cost could change over time. I will review this article at least annually to keep up to date.

The Cost of Depression

Major Depressive Disorder (MDD) is estimated to affect around 19.3 million Americans in 2019 according to the NIMH and SAMHSA. According to the World Health Organization, depression is the leading cause of disability worldwide. In the U.S. workforce, the prevalence of MDD has been estimated at 7.6% (Birnbaum et al., 2010). This means that approximately 6-7% of full-time U.S. workers experienced major depression (MDD) within a year. The total economic burden of MDD is now estimated to be $210.5 billion per year. For every dollar spent on MDD direct costs in 2010, an additional $1.90 was spent on MDD-related indirect costs.

The Cost of Depression Treatment

A study published in the Journal of Clinical Psychiatry in 2018 found that roughly 16% of patients with major depression have a treatment-resistant form of depression. This means that a significant percentage of patients suffering from depression don’t respond to two or more antidepressants. That can cost an average of more than $17,000 per year in healthcare expenditures, compared with $9,700 among non-treatment-resistant-depression patients. Patients with no major depression had average healthcare costs of $4,700, or about four times less than patients with treatment-resistant depression.

Learn more about TMS treatment for depression

The Cost of Antidepressant Medications

New brand name antidepressants are often very expensive. It is very common for patients with TRD (treatment resistant depression) to be on two of the new psychotropic medications. New antidepressants like Trintellix or Viibryd cost about $400 a month. Adding an augmentation medication like Latuda or Rexulti could cost another $1000 a month. Raising the annual bill to the numbers mentioned above of $17000 annually. Unfortunately, the success rate with medications at this point is very poor. We know from STAR*D trial that the overall cumulative remission rate was 67% after 4 stages of antidepressant medication treatments. The fourth stage of the trial had a very low response rate of 13% on the QIDS-SR rating scale and 6.9% on the HAM-D 17 rating scale. In other words, despite the increase in the cost of antidepressants as we go on in the attempts of treating treatment resistant depression, the outcome goes poorer. Simply, the more medications we try the poorer the outcome and higher the cost goes.

Here is what we established so far

Let’s now talk about the cost of TMS.

How much does TMS cost with insurance?

The cost of TMS therapy to the consumer varies by location and insurance plan. The vast majority of insurance plans cover the TMS therapy cost. Patients are usually responsible for their portion of deductibles, copays until they meet their out-of-pocket or their co-insurance. Your TMS clinic usually finds out all of these details for the patient upon request.

The catch with insurance coverage for TMS therapy is that insurance companies typically adopt restrictive criteria not allowing everyone who wants TMS therapy and meet the FDA-clearance to receive the treatment to get it. Let me explain more!

The FDA cleared (and continues to clear more TMS machines) to be used for depression based on the clinical research data presented. Most clinical research on TMS therapy was done on patients who failed one or more antidepressant medications. For this reason, the FDA consider using a TMS therapy machine indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.

The largest commercial insurances in the USA (United Healthcare or Optum) and the second-largest nationally but the largest in Florida (Florida Blue or BCBS) adopt very restrictive criteria before allowing their members the option of TMS therapy. The criteria require the patient to have:

• Failed 4 antidepressants from 2 different classes

• Failed 2 augmentation therapy. Meaning taking 2 medications at the same time.

This is a total of 6 medications. Which literally 6 times as many medications as the FDA required for clearing the use of TMS therapy.

While some of the criteria are based on some clinical evidence. Most of that evidence dates back to STAR*D trial in 2006. A couple of years before the first TMS machine was cleared by the FDA in 2008. Begging the question of how could some insurances decline to cover a new treatment based on old data that didn’t include the new treatment? It is simply an uncalculated cost-saving measure by insurances. It is uncalculated because often times it leads to higher spending on pharmaceutical products and poorer prognosis. Which at the end of the day costs the insurer more money on the member suffering longer from depression.

We have to mention that a few insurance providers are recognizing the benefits and cost savings of TMS therapy and are lowering the criteria for the prior authorization of TMS matching the federal providers. Aetna and Medicare require 2 antidepressants and one augmentation trial. Cigna requires 2 antidepressant medication trials. Tricare requires the failure of other treatment options.

Click here to learn about the success rate of TMS

How much does TMS therapy cost without insurance?

You can easily find out the average cost in your area by searching the CPT codes for the treatment in your local area on the website FairHealthConsumer.org

For example, in our area of Tampa, Florida. The average cost of a full TMS therapy course is about $11,000. Here is how this cost is calculated which you can do for your own local area.

Let’s assume a typical course of TMS therapy. The patient will have 30 treatment sessions + 6 sessions of taper-off if the treatment is successful. This is a total of 36 sessions but the first one is considered mapping. Below I calculated the average in-network cost using 1 CPT code for mapping and 35 CPT codes for regular sessions. In real life, we often do a remapping session in the missile of the treatment which could deviate the total number by a few dollars higher.

CPT code 90867 = $431

CPT code 90868 = $302 X 35 = $10,570

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Total cost of TMS Therapy ~ $11,000

What is the cost per remission of TMS therapy?

As mentioned above, most major insurances cover TMS. Which is helpful to cover the cost mentioned above. But the story is much more complicated than just that. What if a patient didn’t meet the insurance policy to approve TMS? What about patients who are uninsured or want to private-pay for mental health services? How much does TMS cost directly to the consumer? The question in other words is. How much does it really cost to treat a patient with depression using TMS? Luckily, there is an answer to this question too.

A group of researchers did a cost analysis comparing rTMS therapy protocol and iTBS therapy protocol. They found that the cost per remission for rTMS therapy (19 minutes protocol) would be $6,146 while the cost per remission for the new TMS technology; iTBS (3 minutes express TMS) would be $3,695. Please note that the new iTBS protocol is as effective as the old TMS protocol. This was proven in 2018 in THREE-D clinical trial.

How much does TMS therapy cost at Florida TMS Clinic?

At Florida TMS Clinic, we took the guidelines of the above study to guide us through the pricing of TMS therapy. It wasn’t an easy decision to discount our

fee schedule to uninsured patients. This made the cost of TMS therapy at Florida TMS Clinic the best value in Florida. That is despite providing the best TMS technology in our area as Florida TMS Clinic is the only clinic to use navigated

TMS in the Tampa Bay area. We believe that everyone deserves access to the best treatment even when they don’t have insurance or insurance declines to pay for the service they deserve. This means that we treat some patients at a loss, well, let it be!

We all deserve the best access to healthcare. More than ever, we deserve the best access to mental health care. We must stand together to make it a reality.

Click here to learn about the conditions treated with TMS

https://www.floridatmsclinic.com/tampa-tms/ocd-treatment-tampa