Insurance

We accept insurance for TMS services (see below) for covered conditions. We do not accept insurance for any other service, and all services other than TMS are provided on a self-pay basis. We will provide you with a detailed receipt suitable for submission to your insurance plan for possible reimbursement.

 

TMS Insurance Requirements

FDA has cleared TMS for OCD, Bi-Polar depression, and Smoking Cessation in recent years in addition to Medication Resistant Depression (2008). However,  TMS is a covered benefit under most insurance plans in the United States for Medication Resistant Depression only.

Each plan and each insurance company has its requirements.  TMS approval is granted on a case-by-case basis (except Medicare, which does not require prior approval). You do not need a referral for TMS, but we must evaluate you and if TMS is the right treatment for you, make a request for authorization to your health plan.

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

  1. Be 18 years or older
  2. Be diagnosed with severe major depressive disorder
  3. Can NOT have psychotic or schizophrenia
  4. No history of Seizure disorder or epilepsy
  5. No magnetically-sensitive metal within 12 inches from the TMS magnetic coil (Dental implants and disk replacements are OK)
  6. Patient must have tried antidepressants long enough and high enough dosage or must be unable to tolerate the side-effects.

 

Following is each company's medication requirement:

Aetna: 2 antidepressant medications + 1 augmentation

Anthem Blue Cross: 2 antidepressant medications

Blue Shield (Magellan): 4 antidepressant medications 

Cigna: 2 antidepressant medications of 2 different classes (e.g., both can't be SSRI's)

Medicare, Tricare: 1 antidepressant 

United Healthcare (Optum): 4 antidepressant medications 

All companies require at least one or more forms of weekly psychotherapy shown to be effective for depression (Cognitive Behavioral Therapy) for at least two months in the past. 

These are the insurance companies' requirements to pay 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?

Our insurance department will contact your plan's mental health administrators to check your coverage,  co-pays, and deductible. We are in-network with almost all commercial carriers in California; therefore, your co-pay is often the same as your in-network primary care provider on each visit,  usually $20-$35 or $720-$1,260 for a 36 session course of TMS. We will check with your plan for the exact co-pays and deductible before starting your TMS treatment.

 

HOW MUCH DOES IT COST WITHOUT INSURANCE?

We have discounted packages for self-pay clients.  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 has already been paid to 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 to a package before your 10 sessions and apply what you have paid toward a package.

Followings are a list of our services, fees and CPT codes as of 10-01-2020:

 

1. Initial TMS candidacy evaluation - CPT 99205 - $450.00

2. Weekly wellness check (10-15 minutes) - CPT 99213 - $200.00

3. Motor Threshold (each week) - CPT 90869 - $250.00

4. TMS Session (each) - CPT 90868 - $400.00

5. qEEG Brain Mapping (each) - CPT 95812, 95957 and 90889 - $1,75.00

6. IVA Test of Attention (each) - CPT 96138 - $175.00

7. CNS Computerized Cognitive test (each) - CPT 96138 - $275.00

8. Neurofeedback Session (each) - CPT 90901 - $165.00

9. Auditory Training per hour 15 hour minimum - CPT 90901 - $150.00

10. tDCS each session - CPT 90901 - $165.00

 

TMS Discounted Package Prices:

36 TMS Sessions $4,995.00 includes motor threshold

20 TMS Sessions, initial evaluation, wellness visits during your TMS treatment, motor threshold,  qEEG Brain Map,  two IVA Test of Mental Concentration, 2 CNS test of memory, executive function and processing speed (before you start and when finished) for $4,995.00

30 TMS sessions which include the initial evaluation, wellness visits during your TMS treatment, motor threshold test, qEEG Brain Map, two IVA Test of Mental Concentration, two CNS test of memory, executive function and processing speed (before you start and when finished) for $6,950.00

50 TMS sessions which include the initial evaluation, wellness visits during your TMS treatment, motor threshold test, qEEG Brain Map, two IVA Test of Mental Concentration, two CNS test of memory, executive function and processing speed (before you start and when finished) for $8,500.00

Additional Sessions after completion of a package: $150.00

 

If you start your TMS within 30 days, 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 your insurance plan has authorized your TMS treatment, then your payments will be applied towards your deductibles or co-pays and any over-payment refunded. Some of the services, such as qEEG and initial psychiatric evaluation, and weekly wellness visits might not be a covered benefit or covered at a different rate, and you may owe for these services in addition to any co-pays or deductibles you may have for TMS services.


 

Neurofeedback Packages:

10 Neurofeedback sessions $995.00

20 Neurofeedback sessions which include the initial evaluation, qEEG Brain Map, two IVA Test of Mental Concentration ( before you start and when finished)   $2,995.00

45 Neurofeedback sessions which include the initial evaluation, qEEG Brain Map, two IVA Test of Mental Concentration, two CNS tests of memory, executive function and processing speed (before you start and when finished)  $4,995.00

Unlimited Neurofeedback sessions for one year, includes the initial evaluation, 2 qEEG Brain Maps, two IVA Test of Mental Concentration, two CNS tests of memory, executive function and processing speed ( before you start and when finished) $7,500.00

- Additional person from the same family includes unlimited sessions for one year, the initial evaluation, 2 qEEG Brain Maps, two IVA Test of Mental Concentration, two CNS test of memory, executive function and processing speed (before the start and when finished)  $1,995 .00

 

We will credit payments you have made for the Initial evaluation, qEEG Brain Mapping, CNS, and IVA toward the packages that include them, provided you start within 30 days of those payments.


 

Auditory Integration Training

15 Hours AIT  $1,695.00  

30 Hours AIT Includes Audiograms (2), 2 Scan Test of Auditory Processing and Tap test of auditory processing skills $2,995.00

60 Hours AIT Includes Audiograms (up to 3), 2 Scan Test of Auditory Processing and 2 Tap test of auditory processing skills ( before the start and when finished) $4,995.00

90 Hours AIT Includes Audiograms (up to 5), 2 Scan Test of Auditory Processing and Tap test of auditory processing skills ( before the start and when finished) $5,995.00

130 Hours AIT Includes Audiograms (up to 6), 2 Scan Test of Auditory Processing and Tap test of auditory processing skills ( before the start and when finished) $6,995.00

180 Hours AIT Includes Audiograms (up to 9), 3 Scan Test of Auditory Processing and Tap test of auditory processing skills (before starting, after 90 and when finished) $7,995.00

 

We will credit payments you have made for the Initial evaluation, Audiogram, Scan Test of Auditory Processing Disorder, and Taps Test of Auditory Processing skills toward the packages that include them, provided you start within 30 days of those payments. You can upgrade to a larger package within 14 days of finishing a smaller package.


 

Packages are discounted with the assumption of completing the package. If for any reason you do not or cannot complete your package (including if we decide to stop providing services to you for any reason), you will be charged the standard fees for the services provided to you and any balance will be refunded to you.

We do not offer a discount of the package prices because some tests are skipped or clients cannot perform them.

 


There is a $150 charge for missed or cancelled appointments less than 24 hours.

All sessions of a package must be completed within one year of the purchase date.  If not finished, we will close your account out in accordance with our standard rates and issue any refund that might be owed to you. 

Insurance Providers 

Patient Success Stories

"I can't say enough good things about Brain Wellness Center and all their staff! Everyone is super friendly and knowledgeable, and they were able to explain everything to me I'm simple layman's terms… 
Jason J.
"I have struggled with depression my whole life, and for those who also suffer from it, you know It not only affects you, but everyone around you. I had tried multiple medications, but they either we… 
Leonard S.
"Brain Wellness Center changed my life from the beginning. At first I was skeptical just like you all probably are, saying that this procedure would have a decrease or a complete recovery from depres… 
Gianella A.