Do I Qualify For Insurance to Pay for My TMS?

As of 10-10-2020, here are the following requirements from the major insurance companies for coverage. We treat patients on a self-pay basis when they do not qualify for insurance coverage:

1) The patient must be 18 years or older

2) Be diagnosed with severe major depressive disorder

3) Must be in talk therapy for at least six weeks (weekly sessions)

4) No history of seizure disorder or epilepsy

5) No magnetically-sensitive metal within 12 inches from the top of the head (Dental implants and disk replacements are OK)

6) Must have tried antidepressants (see the number below of how many by each insurance company):

Aetna: 2 antidepressants + 1 augmentation (like ADHD, Thyroid, or mood stabilizer medication)

Anthem Blue Cross: 2 antidepressant medications

Beacon-Carelon: 4 antidepressant medications

Blue Shield (Magellan): 4 antidepressant medications

Cigna - Evernorth: 2 antidepressants from 2 different classes (e.g., both can't be SSRI's)

Humana: 1 antidepressant

Magellan: 2 antidepressants

Medicare: WE ARE NOT ACCEPTING Medicare Patients at this time 1 antidepressant

Meritain: 4 antidepressants

MHN: 4 antidepressants

Optum: 2 antidepressants

TriCare/TriWest: 1 antidepressant

United: 4 antidepressants

UMR: 4 antidepressants

Medi-Cal: The level of coverage differs depending on the county

These requirements are the same for TMS service in any facility in the United States.

There are many people who do not wish to try so many medications or have a preference for a non-medication option.

We treat many patients each month that do not qualify for insurance coverage or for different conditions such as ADHD, Autism, PTSD, TBI, and Anxiety on a self-pay basis.

WHAT IS MY CO-PAY?

We are pleased to inform you that we are in-network with almost all health plans in California for TMS treatment. This means that for most of our patients, the co-pay is typically between $20 to $35 for each visit, similar to what you would pay when visiting your regular doctor. For the 36-session course of TMS treatment, this comes to a total of $720 to $1,260.

Our insurance department will contact your plan administrators to verify your coverage, co-pays, and deductibles. We will also handle all the necessary paperwork required by your health plan to obtain prior authorization for your TMS treatment, provided you meet their guidelines. Once we receive approval, we will inform you of your co-pay and deductible before commencing your TMS treatment.

However, please note that some services, such as qEEG Brain Mapping, cognitive skills tests, and the initial psychiatric evaluation, may not be covered by your insurance plan or may be covered at a different rate. If this is the case, you may be responsible for paying for these services in addition to any co-pays or deductibles.

We believe that qEEG Brain Mapping is essential for customizing the treatment to each patient's unique brain patterns and achieving a better outcome. While EEG recording is typically covered by most insurance plans, coverage payment is dependent on medical necessity, such as a history of seizures. In case your insurance plan does not cover this procedure, we offer a self-pay discounted option of $995.00 (instead of $2,995) conditioned on completing 36 TMS sessions. Please note that if you fail to complete the full course of treatment, this discount will be lost, and the full price will apply. These services are always included in our self-pay packages.

HOW MUCH DOES IT COST WITHOUT INSURANCE?

Each session of TMS is $400 but can be as low as $225 a session in packages for self-pay clients. If you prefer not to commit to a package, you can pay for each session individually at $400 a session.

You have the flexibility to begin with a smaller package and, if you wish, upgrade to a larger one within 14 days of completing your package by covering the price difference. This allows you to enjoy the lower pricing associated with the larger package. If you choose to purchase a package but do not use the full number of sessions included in that package, the services you receive will be charged at our regular service rate, and any remaining balance will be refunded to you. This ensures that your total expenditure remains consistent with what you would have paid if you had opted for individual sessions.

It's important to note that some services, such as qEEG Brain Mapping and cognitive skills tests, may not be covered by insurance or may be covered at a different rate. In these cases, you may owe for these services in addition to any co-pays or deductibles. However, these services are always included in our self-pay packages.

We believe that qEEG Brain Mapping is crucial to customize treatment and reduce the remote possibility of a seizure during treatment. If your insurance plan does not cover this procedure, we offer a self-pay discounted option of $995.00 instead of $2,995, provided you complete 36 TMS sessions. However, if for any reason you do not complete 36 sessions, regardless of the reason, you will lose this discount and be charged the full price.

You can start by paying for each service you need until you have decided on a course of therapy. For example, you can start with qEEG Brain mapping and test of attention and the initial evaluation. After reviewing the results, you can start with TMS, neurofeedback, or Auditory Training and apply what you have paid toward the package price (check to see what is included in each package). You can even start by paying for treatments on a per-session-bases for neurofeedback or TMS (according to our standard rates). You can then convert it to a package and apply what you have paid toward a package.

The followings are a partial list of our Standard Fees and relevant CPT codes as of 01-01-2023 (prices are subject to change without notice):

Service ( Many of these services are already included in the Treatment packages)	CPT Code	Fee
1) Psychiatric review for TMS candidacy (in-person or via Tele-Video), reviewing chart notes and history and test results (written report or signing forms such as Social Security or School Accommodations are not included and must be discussed before evaluation and will cost more)	CPT 99205	$650.00 ( Included in most TMS packages)
2) qEEG Brain Mapping with a written report by California Licensed Board Certified Neurologist (qEEG reveals how brain networks and regions are functioning and, compared to multiple databases, how they should be). If you need a diagnosis, you need to include at the very least, item 1 above.	CPT 95812, 95957 and 90889	$2995.00 This price includes items 3 and 4 (IVA and CNS) qEEG is included in most of our TMS and Neurofeedback packages for self-pay patients. Patients paying for TMS through insurance will pay only $995.00 if they complete 36 TMS sessions.
3) The Integrated Visual and Auditory (IVA) Continuous Performance Test of Attention and Mental Concentration measuring Auditory Attention, Visual Attention, Sustained Auditory Attention, Sustained Visual Attention, Auditory Elasticity, Visual Elasticity, Auditory Speed, Visual Speed, Auditory Impulse Control, Visual Impulse Control, Auditory Stamina, Visual Stamina, Fine Motor Hyperactivity, Auditory Comprehension, Visual Comprehension, Auditory Persistence, Visual Persistence, Auditory Sensory/Motor, Visual Sensory/Motor	CPT 96138	$450.00 Included in certain TMS and Neurofeedback packages for self-paying patients.
4) Computerized Neurocognitive Screening ( CNS ) Testing Visual memory, Verbal Memory, Reaction Time, Complex Attention, Simple Attention, Sustained Attention, Cognitive Flexibility, Processing Speed, Executive Function, Reasoning, Social Acuity, Working Memory, Motor Speed, Psychomotor Speed, Reaction Time and Neurocognition Index compared to the same-age population	CPT 96138	$575.00 Included in certain TMS and Neurofeedback packages for self-paying patients.
5) Wellness check (weekly while doing TMS)	CPT 99213	$200.00 Included in certain TMS and Neurofeedback packages for self-paying patients.
6) Motor Threshold to determine how much magnetic stimulation is required	CPT 90869	$250.00 Included in certain TMS and Neurofeedback packages for self-paying patients.
7) Initial Consultation meeting with our Center Director ( not a diagnostic evaluation)	CPT V68.20	$195.00 Included in certain TMS and Neurofeedback packages for self-paying patients.
8) TMS Session (please see discounted package below)	CPT 90868	$400.00 ( Can be as low as $180 in TMS packages). This amount will be credited towards any TMS package, so once an amount equal to the price of a package has been paid, the balance of sessions in that package is free.
9) Neurofeedback or tDCS Session (see discounted packages below)	CPT 90901	$175.00 (Can cost as low as $75 in Neurofeedback Packages)
10) Auditory Training per hour (see discounted packages below)	CPT 90901	$175.00 (Can cost as low as $80 in Auditory packages)
11) Auditory Processing Skills Assessment compared to similar age populations (includes CNS and IVA, items 3 and 4 above)	CPT 96138	$995.0.00 Included in Auditory Training packages.
12) ADHD Diagnosis (Includes services listed above 1,2,3,4, symptoms rating forms, and review of records) 13) Full Diagnostic Evaluation ( Suitable for ACT, SAT, LSAT, GMAT, Bar Exam, etc.)	Multiple Codes	$3,795.00 ( $2,500 applied towards certain Neurofeedback or TMS Packages) $5,500-$7,500
14) 504 School accommodations in accordance with Americans with Disabilities after diagnostic services.	Multiple Codes	$350.00
15) Forms including work leave of absence, short term-disability forms, or requests for modifications or accommodations (WE DO NOT COMPLETE ANY DOCUMENTS FOR LONG-TERM DISABILITY) 16) Legal work involving depositions or appearing as an expert witness in a legal proceeding	Multiple Codes	$500.00 $750.00 per hour with a minimum of 4 hours plus all travel time and expenses

We accept insurance for the Treatment of Medication Resistant Depression using TMS.

We can check your insurance plan's coverage for TMS only.

TMS Packages

Cost per session is $400.00. The first session is $650.00 (becuase it involves extra time to establish location of treatment and the power setting).

We offer discounted packages for TMS sessions, which can significantly reduce the cost per session to as low as $225.00. The packages are available for 36 sessions, and the details are listed below. If you sign up for a package but choose to discontinue it before completing all sessions, you will be charged the standard rates, which are $650 for the first session and $400 for subsequent sessions. Any balance remaining after the charges will be refunded to you.

Start with a small package and upgrade to a larger package later by paying the difference. You still get the same discount as if you had started with a larger package.

PLEASE NOTE THAT MOST CLIENTS NOTICE CHANGES BETWEEN 15 TO 25 SESSIONS.

- 20 TMS sessions:

This is the starting point if you are undecided about TMS. 20 sessions are typically when there are some improvements are observed and experienced in most patients but not sufficient for remission.

Include the initial evaluation, 1 qEEG Brain Map, up to 3 wellness visits during your TMS treatment, up to 1 motor threshold test, 1 IVA Test of Mental Concentration, 1 CNS test of memory, executive function, and processing speed before you start and when finished (These are optional services and included in this package. There are no extra charges for them, nor is there any credit if not done). $6,995.00

You can upgrade to a larger package within 14 days of finishing a smaller package.

We will credit payments you have made for the Initial TMS candidacy evaluation, qEEG Brain Mapping, CNS, and IVA toward a package that includes them if you start your TMS within 30 days.

- 36 TMS sessions:

Include the initial evaluation, 1 qEEG Brain Map, up to 4 wellness visits during your TMS treatment, up to 2 motor threshold tests, 2 IVA Test of Mental Concentration, 2 CNS tests of memory, executive function, and processing speed before you start and when finished (These are optional services and included in this package. There are no extra charges for them, nor is there any credit if not done). $8,995.00

You can upgrade to a larger package within 14 days of finishing a smaller package.

We will credit payments you have made for the Initial TMS candidacy evaluation, qEEG Brain Mapping, CNS, and IVA toward a package that includes them if you start your TMS within 30 days.

- 50 TMS sessions :

Include the initial evaluation, up to 6 wellness visits during your TMS treatment, up to 3 motor threshold tests, 2 qEEG Brain Map, up to 3 IVA Tests of Mental Concentration, up to 3 CNS tests of memory, executive function, and processing speed before you start and when finished (These are optional services and included in this package. There are no extra charges for them, nor is there any credit if not done). $10,995.00

You can upgrade to a larger package within 14 days of finishing a smaller package.

We will credit payments you have made for the Initial TMS candidacy evaluation, qEEG Brain Mapping, CNS, and IVA toward a package that includes them if you start your TMS within 30 days.

Additional Sessions:

After completion of a package (must start within 30 days of finishing a package): $225.00

We will credit payments you have made for the Initial TMS candidacy evaluation, qEEG Brain Mapping, CNS, and IVA toward a package that includes them if you start your TMS within 30 days.

If you had services before starting TMS and your insurance plan authorizes your TMS treatment, you will receive the discounted pricing offered to TMS clients ($995 for a qEEG brain map instead of $2,995 provided you complete 36 sessions). Over-payments are applied toward your deductibles or co-pays, and any overpayment is refunded.

Here is how packages work:

You are charged our Standard Rates for the services you are receiving. Once the amount of these charges has equaled your package price, the remaining services are being offered free of charge until the end of the package, provided you finish them within 12 months of starting. If the package is not completed for any reason, you are charged our standard fees and any remaining balance will be refunded. This will cause you to lose your discount but you are not paying any more than if you did not purchase a package. No credit is given if some tests and assessments are not done.

20 session package: After the 9th session, you are paid-up and the remaining 11 sessions are free to use within 12 months of starting.

36 session package: After the 13th session you are paid-up and you have 24 free sessions that you can use within 12 months of starting.

50 session package: After the 18th session you are paid-up and you have 33 free sessions to use within 12 months of starting.

(prices are subject to change without notice)

NEUROFEEDBACK AND AUDITORY INTEGRATION TRAINING IS CONDUCTED AT THE COMFORT OF YOUR OWN HOME REMOTELY

Neurofeedback Packages

Neurofeedback sessions (50 minutes) are $175.00 each. You can pay as you go, or pre-pay for a package of sessions as outlined below. You can do neurofeedback at home under our supervision or in our office.

Start with a small package and upgrade to a larger package later by paying the difference. You still get the same discount as if you had started with a larger package.

- 20 Neurofeedback sessions

Includes the initial evaluation, one (1) qEEG Brain Map, two (2) IVA Tests of Mental Concentration ( before you start and when finished), $3,995.00 ( 2 Month FREE online access fee is included, additional monthly online access fee of $125 after 2 months).