TMS: the complete guide

What it is

TMS uses a magnetic coil held against the scalp to deliver pulses that stimulate the left dorsolateral prefrontal cortex, a region underactive in depression. No anesthesia, no medication, no memory effects. The FDA cleared it for major depression in 2008 and for obsessive-compulsive disorder in 2018; newer protocols (theta burst, deep TMS, accelerated schedules) are cleared as well. See the TMS hub, the coverage hub, the coverage checker, treatment comparisons and condition and treatment pages.

Who qualifies

Insurers and Medicare converge on the same criteria:

1. Moderate to severe major depressive disorder on a standard rating scale.
2. Failure of two to four antidepressant trials at adequate dose and duration (or intolerance).
3. A trial of evidence-based psychotherapy, or a documented reason it was not appropriate.
4. No seizure disorder and no ferromagnetic metal in or near the head.

TMS for OCD, PTSD or anxiety is usually excluded from coverage even where it is FDA cleared.

What treatment involves

• Mapping visit: the clinician locates your motor threshold to set the dose. About an hour.
• Daily sessions: 20 to 40 minutes, five days a week, for six weeks, then a taper of six sessions over three weeks. Standard courses total 36 sessions. Accelerated protocols compress this into one to two weeks with several sessions a day.
• Sensation: tapping on the scalp and jaw muscle twitching. Headache and scalp discomfort are the common side effects and fade within the first week. Seizure risk is under 1 in 1,000 with screening.

You drive yourself home. Most people work the same day.

Results

About half to two thirds of patients respond, and roughly a third reach remission after a first course. Effects last a year or more for many; re-treatment for relapse is covered when the first course produced a documented response.

Insurance

Most commercial plans and Medicare cover TMS with prior authorization (Original Medicare covers it under Local Coverage Determinations with no prior authorization). See TMS coverage by insurer and the Medicare and TMS page.

Cost

Insured patients typically pay 0 to 0 per session after deductible, so plan your out-of-pocket maximum: 36 sessions add up quickly. Cash prices run 50 to 00 per session or ,000 to 4,000 per course. See TMS cost.