If you have United Healthcare and are considering TMS therapy, you might be wondering if your treatment can be covered by insurance. The good news is that United Healthcare does cover TMS therapy for adults with major depressive disorder, as long as you meet certain criteria.
In this blog post, we’ll explain everything you need to know about United Healthcare Insurance coverage for TMS therapy, including what it covers, what it doesn’t, and the process of getting insurance coverage for TMS therapy.
What is TMS therapy?
Transcranial magnetic stimulation (TMS) therapy is a non-invasive treatment that uses gentle magnetic pulses to stimulate specific regions of the brain involved in mood regulation. It’s most commonly used to treat major depressive disorder (MDD), particularly for those who haven’t found relief through medication or talk therapy (known as treatment-resistant depression or TRD).
TMS is non-systemic. This means that, unlike medication, it targets the brain directly without affecting the rest of the body. During a TMS session, a device is placed against the scalp which sends focused magnetic pulses to stimulate underactive neural pathways. Over time, these treatments help to relieve symptoms and rebalance brain activity.
See: How Successful is TMS Therapy?
There are two main types of TMS:
- Repetitive TMS (rTMS): This is the most widely-used form of TMS therapy. It delivers repeated pulses to the dorsolateral prefrontal cortex (DLPFC), a part of the brain known to play a role in mood and emotional regulation.
- Deep TMS (dTMS): This type of TMS uses a specialized helmet with an H-coil designed to reach deeper brain structures. It stimulates a broader part of the brain and is often used for those with obsessive-compulsive disorder (OCD) or in treatment-resistant cases.
Most TMS sessions last between 20 and 40 minutes. You’ll be fully awake throughout the treatment and it doesn’t require any downtime, so you’re free to return to daily activities immediately afterwards. A typical TMS treatment plan involves five sessions per week for a total of four to six weeks, although this can vary depending on your needs. More condensed versions of the treatment are available through accelerated TMS or SAINT TMS.
One of the main benefits of TMS is that it’s mostly well-tolerated, although some people might experience mild and temporary side effects such as light headaches or scalp sensitivity. These tend to be short-lived and resolve on their own as you progress with treatment. More serious side effects, like seizures, are extremely rare and occur in about 1 in every 10,000 sessions.
Note that TMS is not the same electroconvulsive therapy (ECT). TMS doesn’t induce seizures, doesn’t require sedation, and has no recovery time. It also uses magnetic pulses while ECT involves sending an electrical current through the brain.
Read More: TMS vs. ECT: Which is better?
What is TMS therapy FDA-approved to treat?
TMS has been FDA-approved to treat a number of mental health and neurological conditions, including:
- Major depressive disorder (MDD): TMS is most commonly used to treat adults with major depression who haven’t responded to at least two antidepressant medications, or experienced unpleasant side effects.
- Obsessive-compulsive disorder (OCD): Deep TMS is FDA-approved for adults with moderate to severe OCD, particularly those who haven’t seen improvement with medication or therapy alone.
- Smoking cessation: TMS has also been approved to help people quit smoking. Studies show that TMS can help reduce nicotine cravings and make it easier to cut back or quit smoking altogether.
- Migraine prevention: Certain TMS devices are approved for treating and preventing migraine headaches.
TMS can also help treat a range of other conditions, including anxiety disorders, post-traumatic stress disorder (PTSD), and chronic pain, although these are currently considered off-label uses.
Read More: TMS for Migraine: Benefits, Effectiveness, Precautions
Does United Healthcare cover TMS therapy?
Yes, United Healthcare Insurance does cover TMS therapy for eligible adults diagnosed with major depressive disorder (MDD), particularly when other treatments like antidepressants or therapy haven’t been effective. TMS is listed under United Healthcare’s outpatient mental health services and is considered medically necessary when specific clinical criteria are met.
What United Healthcare requires for TMS coverage
To qualify for TMS coverage through United Healthcare, you must meet the following criteria:
- Be 18 years or older
- Have a confirmed diagnosis of major depressive disorder (MDD)
- Have not responded to at least two antidepressant medications from different drug classes at therapeutic doses OR have a prior positive response to TMS in an earlier depressive episode (with at least 50% symptom improvement).
Additionally:
- Your depression symptoms must be documented using a validated scale (like the PHQ-9, BDI, or HAM-D)
- TMS must be delivered using an FDA-approved device
- Your treatment must be prescribed and supervised by a psychiatrist trained in TMS.
A typical course of treatment includes up to 30 sessions, followed by 6 tapering sessions over several weeks.
If you’d like to explore insurance coverage with United Healthcare, we can help verify your eligibility and handle the prior authorization process. We’ll work directly with United Healthcare to submit all the required documentation so you can focus on getting the treatment you need.
Does United Healthcare cover TMS retreatments?
In case of a relapse, United Healthcare may approve TMS retreatment if:
- At least six months have passed since your last TMS session
- Your symptoms have returned despite ongoing treatment (e.g. therapy or medication)
- You had a positive response to your last course of TMS (usually measured by a 50% improvement or more).
What United Healthcare doesn’t cover
United Healthcare doesn’t cover all uses of TMS. Some treatments are considered investigational, not medically necessary, or lacking sufficient clinical evidence.
United Healthcare doesn’t currently cover TMS therapy for:
- Individuals who are pregnant or breastfeeding
- Individuals experiencing acute psychiatric emergencies, such as psychosis or active suicidality
- Maintenance or booster TMS sessions beyond the initial treatment plan
- Accelerated protocols, including Theta Burst Stimulation (TBS), navigated TMS (nTMS), accelerated TMS, or SAINT TMS
- Mental and behavioral conditions, including OCD, PTSD, bipolar disorder, autism spectrum disorder, anxiety (unless MDD is the primary diagnosis), substance abuse (unless MDD is the primary diagnosis), schizophrenia, or other psychotic disorders
- Medical and neurological conditions, including Alzheimer’s disease, chronic neuropathic pain, epilepsy, dystonia, headaches or migraines, Parkinson’s disease, stroke, tinnitus, or traumatic brain injury (TBI).
Please note – if you’re interested in TMS for a condition not covered by insurance, we encourage you to still reach out to our team. We specialize in TMS therapy for a range of conditions and can walk you through your options for private-pay treatment or alternative solutions that may be right for your needs.
Read: What Makes SAINT TMS Different From Regular TMS?
How to get insurance coverage for TMS therapy
Getting insurance coverage for TMS therapy can feel overwhelming, but it doesn’t have to be – our team is here to guide you through every step of the process.
If you’re considering TMS and have United Healthcare Insurance (or another major provider), here’s what to expect:
1. Get a diagnosis from a licensed provider
First, you’ll need a formal diagnosis from a licensed mental health provider. TMS is typically covered by United Healthcare for adults with major depressive disorder who haven’t had success with at least two antidepressants.
Your diagnosis must align with criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and be supported by a thorough clinical evaluation. If you haven’t yet received a diagnosis, we can schedule a consultation to start the process. Contact us now.
2. Document your treatment history
United Healthcare requires evidence that previous treatments haven’t worked. Specifically, you’ll need to show that:
- You’ve tried at least two antidepressants, from different classes, at adequate doses and durations (often four weeks or more)
- You’ve also completed a trial of evidence-based psychotherapy without meaningful relief.
If you’ve had success with TMS in the past, showing a 50% or greater improvement in symptoms using a standardized rating scale might also qualify you for coverage.
Not sure if you have all the necessary records? Don’t worry! We’ll help you track them down and coordinate with any past or current providers so you don’t have to.
Read More: What to Do When Antidepressants Don’t Work for You (and Why)
3. Complete a standardized symptom assessment
United Healthcare requires providers to use validated rating scales (such as the PHQ-9 or HAM-D) before and during treatment to document the severity of your depression and monitor your progress.
This is part of our standard intake process here at BestMind. We’ll walk you through everything during your consultation and treatment planning.
4. Submit a preauthorization request
Once we’ve confirmed that TMS is appropriate for you, we’ll submit a prior authorization request to United Healthcare. This submission includes information like:
- Your diagnosis
- Treatment history
- Results from standardized assessments
- Proposed treatment plan (usually 30 to 36 sessions)
- Documentation of medical necessity.
Our insurance team will handle the entire preauthorization process for you, working directly with United to make sure all documentation is submitted correctly and on time. That’s one less thing for you to worry about!
5. Review your out-of-pocket costs
Even with insurance coverage, your plan might include deductibles, co-pays, or co-insurance, which might mean you have to pay for part of the treatment yourself. We’ll verify your benefits with United Healthcare and give you a clear estimate of what your treatment might cost so there are no surprises later on.
Does United Healthcare cover TMS therapy? FAQs
How do I know if my insurance covers TMS therapy?
TMS is covered by most major insurance plans, but our team can help you understand your specific benefits for mental health treatment. We’ll contact your insurance provider directly to confirm eligibility, walk you through your coverage details, and answer any questions about costs or requirements.
Don’t hesitate to contact us now to discuss your insurance coverage.
Does United Healthcare cover TMS therapy for depression?
Yes, United Healthcare covers TMS for adults diagnosed with major depressive disorder, including treatment-resistant depression, as long as specific criteria is met. This includes having tried at least two antidepressants without success and completing a trial of psychotherapy.
Does United Healthcare cover TMS for conditions other than depression?
United Healthcare does not currently cover TMS therapy for conditions like anxiety, PTSD, OCD, ADHD, autism spectrum disorder, migraines, or other mental health issues unless major depressive disorder is the primary diagnosis.
Keep Reading: TMS for OCD: Evidence, Side Effects, Benefits, and What to Expect
What if I’ve already had TMS before?
United Healthcare may cover TMS retreatment if you’ve previously benefited from TMS and your symptoms have returned at least six months after your last treatment. To qualify, you must meet the same criteria as for initial treatment and show you’ve previously improved at least 50% on a standardized depression scale.
Does United Healthcare cover maintenance TMS sessions?
At this time, United Healthcare does not cover maintenance TMS therapy or booster sessions. Only the initial course and documented retreatments are considered medically necessary.
How many TMS sessions does United Healthcare cover?
United Healthcare covers a typical course of up to 30 TMS sessions followed by 6 tapering sessions.
How much does TMS therapy cost?
Without insurance, a full course of TMS therapy can range from $10,000 to $15,000 but it depends on the type of treatment and number of sessions you’ve been recommended.
Need help getting started?
Navigating your insurance coverage can feel complicated, but we’re here to help. If you’re not sure whether you qualify, our team can:
- Contact United Healthcare on your behalf
- Walk you through the prior authorization process
- Confirm your coverage, costs, and the next steps.
Mental health care is important and our team will provide the support you need to make an informed decision. Contact us today to see if you’re eligible for insurance coverage or to arrange a TMS consultation.
