To follow is a brief summary of major insurers in CO and their coverage policies. These are subject to change and based on our own research. Please consult your insurance to verify. For all insurers, these basic criteria are required:

• Patient is 18 years of age or older. TMS is now FDA approved to treat major depressive disorder in adolescents down to age 15, but most insurers do not have coverage policies for this age group yet.

• Patient has a current diagnosis of Major Depressive Disorder and the severity is at least moderate to severe based on a standardized rating scale (such as the PHQ-9).

• The current episode of depression must have some level of treatment resistance. This typically involves a range of antidepressant failure from as little as one up to as many as four failed medications. The medication trials must be of adequate duration and dose and have resulted in less than 50% improvement based on a standard rating scale. Medication intolerance can also count in place of lack of response. 

• A documented previous course of failure to psychotherapy of sufficient time and frequency is also often required.

• Prior treatment response to TMS of at least 50% improvement in symptoms can alternatively be used to authorize repeat treatment. Maintenance treatment is NOT covered, but retreatment with sufficient time having passed since the last TMS therapy course is covered.

• If a patient is a candidate for ECT, but cannot pursue or declines ECT treatment for a valid concern (or has a history of intolerance/side effects to ECT), TMS will typically be covered.

• There are a few exclusion criteria to TMS - The patient cannot have ferromagnetic material near the brain/treatment site or medical devices in the neck or head that may respond to magnetic fields. The patient should also not have active psychosis (or a psychotic disorder diagnosis), current suicide intent or action, active abuse of alcohol or drugs, or be pregnant or nursing. The patient must also not have a seizure disorder or other condition that places them at high risk for seizure.

A covered course of TMS therapy typically involves 30 treatments daily M-F for 6 weeks with an additional 6 tapering treatments spread over 3 weeks. It must be prescribed and monitored by a Psychiatrist or similar provider with psychiatric medication prescribing privileges. Rating scales must be utilized during care.

Obsessive Compulsive Disorder has been shown to respond to TMS therapy and TMS was approved for augmentation OCD treatment by the FDA in 2018. Unfortunately, many insurance providers are slower to add newer therapies to their policies, but Cigna and some non-Anthem BCBS plans do have coverage policies supporting TMS for OCD. Other mental health disorders including PTSD and anxiety disorders have also demonstrated significant benefits from TMS but are not, as yet, approved by the FDA for TMS treatment and consequently are omitted from insurance coverage.

Inspire TMS Denver works closely with our insurance benefits and billing department to ensure patients are fully informed of any copay, coinsurance, and/or deductible that may be required for services. Inspire TMS Denver also establishes single case agreements for any clients with insurance that we are not paneled with currently.