Does Medicare Cover TMS Therapy Like Neurostar?
- Medicare can cover Neurostar treatment if your doctor says it’s medically necessary to treat depression. Learn how Medicare pays for Neurostar and how much you can expect to pay for coinsurance or copays.
Neurostar is a machine that administers Transcranial Magnetic Stimulation (TMS) for cases of severe depression.
Medicare beneficiaries may be pleased to learn that this type of therapy — whether provided using a Neurostar machine or another brand — is covered by Medicare when used for depression treatment.
When Does Medicare Pay for Neurostar?
Medicare covers Neurostar when a beneficiary has first been diagnosed with Major Depressive Disorder. The beneficiary must then meet at least one of the following criteria:
- Complete four trials of antidepressants and show a lack of clinically significant response
- Have an inability to tolerate the side effects of four antidepressants
- Have a history of good response to TMS in a previous episode
In addition, these four things could limit your Medicare coverage for Neurostar or TMS treatments:
- A history of seizures
- Psychotic symptoms in the current depressive state
- The presence of an implanted magnetic-sensitive item located within 30 centimeters of were the TMS magnetic field coil is placed
- Having either epilepsy, cerebrovascular disease, dementia, increased intracranial pressure or a history of repetitive or severe head trauma
Medicare does not cover TMS therapy for anxiety or other conditions.
As with most things covered by Medicare, the Neurostar or other TMS therapy must be performed by a licensed physician who accepts Medicare.
How Much Does Neurostar Cost With Medicare?
TMS therapy is typically performed in an outpatient setting and is covered by Medicare Part B, which requires an annual deductible of $203 (in 2021) followed by a 20% coinsurance payment for the remaining cost of covered care.
All Medicare Advantage (Medicare Part C) plans also cover Neurostar and TMS therapy. Medicare Advantage plans are required by law to provide at least the same coverage as Medicare Part A and Part B. Deductibles and coinsurance requirements may vary by plan.
What Is TMS?
Transcranial Magnetic Stimulation is a noninvasive medical procedure that utilizes magnetic fields to stimulate the regions of the brain responsible for mood and depression. The magnetic pulses are delivered through a coil that is placed atop the patient’s head and work to alter the brain’s chemistry and reduce the symptoms of depression.
TMS is recommended for patients with Major Depressive Disorder who have failed to benefit from initial treatment of their depression.
A TMS treatment session may last for 30 minutes to an hour and a number of sessions are typically required to achieve results.
TMS has no major side effects and does not cause memory loss or seizures.