Insurance & Costs

We accept insurance for treatment of Medication-Resistant Depression by using TMS Only

 

All other services 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.

 

 Insurance Requirements to Cover TMS in California

We are In-Network with all commercial health Plans and MediCare in California as a TMS provider. We do not accept Kaiser, Medical or County plans.

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.

We offer treatment on a self-pay basis when the patient does not qualify for insurance coverage or wants a faster treatment than insurance covers. Insurance coverage is limited to one session a day, a maximum of 5 a week while self-pay patients can do up to 5 sessions a day, 7 days a week. This means that a self-pay patient can complete a full course of treatment in about one week. A typical course of treatment is 36 sessions for depression. 

 

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 self-pay bases 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 have tried talk therapy for at least 2 months (weekly sessions) 
  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. The patient must have tried antidepressants (see the number below of how many by each insurance company):

Aetna: 2 antidepressant medications + 1 augmentation

Anthem Blue Cross: 2 antidepressant medications

Blue Shield (Magellan): 4 antidepressant medications 

Cigna2 antidepressant medications of 2 different classes (e.g., both can't be SSRI's)

Medicare, Tricare: 1 antidepressant 

United Healthcare (Optum): 4 antidepressant medications 

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 Insurance CO-PAY?

We are in-network with almost all health plans in California. In most cases, your co-pay is the same as what you would pay when you visit your regular doctor. For a majority of our patients, this co-pay is between $20 to $35 for each visit. That means a total of $720 to $1,260 for all the 36 session course of TMS. We will check with your plan and let you know of your portion before you start.

Some services, such as qEEG Brain Mapping, cognitive skills tests, and the initial psychiatric evaluation 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. Our insurance department will contact your plan's administrators to check your coverage, co-pays, and deductible. We will complete all the paperwork required by your health plan in order to get prior authorization for your TMS treatment provided you meet their guidelines. Once we have received approval,  you will be informed of this information as well as your co-pay and deductible before starting your TMS treatment.

We believe that qEEG Brain Mapping helps to reduce the remote possibility of a seizure ( only one in 30,000 treatments has resulted in a seizure during treatment only and we have never had one). qEEG Brain Mapping helps to customize the treatment to each patient's unique brain patterns and results in a better outcome. If your insurance plan does not cover this procedure ( although EEG recording is covered by most insurance plans, coverage payment is dependent on medical necessity such as a history of seizures), we offer a self-pay discounted option of $650.00 instead of $1,750. This highly discounted price is available only to patients doing TMS with insurance authorization who complete their authorized sessions. If the full course of treatment (36) is not completed, the standard rate of $1,750.00 applies.

 

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 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 to a package before your 10th  sessions and apply what you have paid toward a package.

Followings are a partial list of our services and Standard Fees and CPT codes as of 01-01-2021:

Service CPT Code Fee
1) Initial Psychiatric Evaluation for TMS or Medication (written report or signing forms such as Social Security or School Accommodations are not included and must be discussed before evaluation and will cost significantly more) CPT 99205 $650.00
2) qEEG Brain Mapping with a written report by California Licensed Board Certified Neurologist (qEEG reveal how brain network 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 $1,750.00
3) The Integrated Visual and Auditory (IVA) Continuous Performance Test of Attention and Mental Concentration CPT 96138 $175.00
4) Computerized Cognitive Test of memory, executive function, attention, and processing speed CPT 96138 $275.00
5) Wellness check (weekly while doing TMS) or monthly for medication management CPT 99213 $200.00
6) Motor Threshold to determine how much magnetic stimulation is required CPT 90869 $250.00
7) Initial Consultation meeting with our Center Director ( not a diagnostic evaluation) CPT V68.20 $195.00
8) TMS Session (please see discounted package below) CPT 90868 $400.00
9) Neurofeedback or tDCS Session (see discounted packages below) CPT 90901 $165.00
10) Auditory Training per hour (see discounted packages below) CPT 90901 $150.00
11) Auditory Processing Skills Assessment compared to similar age population CPT 96138 $250.00
12) ADHD Diagnosis (Includes services listed above 1,2,3,4, symptoms rating forms, and review of records) Multiple Codes $2,500.00
13) 504 School or Work accommodations in accordance with American with Disabilities after diagnostic services Multiple Codes $250.00
14) Diagnostic Evaluation for ACT, SAT, LSAT, GMAT, Bar Exam, etc Multiple Codes $4,500-$6,500

 

 

TMS Packages

​​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 your insurance plan does authorize 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.

20 TMS Sessions, initial evaluation, wellness visits during your TMS treatment, motor threshold, for $4,995.00. MediCal and County Health Plan members get 36 sessions for the same price.

- 36 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 $7,500.00

50 TMS sessions which include the initial evaluation, wellness visits during your TMS treatment, motor threshold test, 2 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 $9,500.00

Additional Sessions after completion of a package: $150.00

Here is how packages work: You are being charged our Standard Rate for the services you are receiving. Once the amount of services has equaled your package price, the remaining services are being offered as free until the end of the package.  If you do NOT complete your package (including if we decide to stop providing services to you), you will be charged the standard fees for the services. This will cause you to lose your discount but you are not paying any more than having no package. 

If you have paid by credit card, 6% will be deducted from any refund which is what we get charged for credit card processing (3% for the charge and another 3% for refunding) 


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

 

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

*Home training program requires an Ipad or a Tablet, a stand, a Muse Headset, 10-20 Paste, and one Electord (all total about $300-$400) and  monthly access fee of $125.00

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.

 

Here is how packages work:  You are being charged our Standard Rate for the services you are receiving. Once the amount of services has equaled your package price, the remaining services are being offered as free until the end of the package.  If you do NOT complete your package (including if we decide to stop providing services to you), you will be charged the standard fees for the services. This will cause you to lose your discount but you are not paying any more than having no package. 

If you have paid by credit card, 6% will be deducted from any refund which is what we get charged for credit card processing (3% for the charge and another 3% for refunding) 

 


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

 

Auditory Integration Training

10 Hours Berad Auditory Training $995.00

20 Hours of Berard Auditory Integration Training $1,895.00  

- 30 Hours of our hybrid combined Berard and Tomatis Auditory Integration Training includes Audiograms (2), 2 of  Test of Auditory Processing Disorder and Test of Auditory Processing skills $2,495.00

- 60 Hours of our hybrid combined Berard and Tomatis Auditory Integration Training Includes ( Audiograms up to 3), 2  of Test of Auditory Processing Disorder and 2 of Test of Auditory processing skills ( before the start and when finished) $4,995.00 (In children unable to do these tests, we will replace it with a qEEG brain map)

- 90 of our hybrid combined Berard and Tomatis Auditory Integration Training includes Audiograms (up to 5), 2  of Test of Auditory Processing Disorder, and 2 of Test of Auditory processing skills ( before the start and when finished) $5,995.00 (In children unable to do these tests, we will replace it with a qEEG brain map)

- 130 Hours of our hybrid combined Berard and Tomatis Auditory Integration Training Includes Audiograms (up to 6), 2  of Test of Auditory Processing Disorder, and 2 of Test of Auditory processing skills ( before the start and when finished) $6,995.00 (In children unable to do these tests, we will replace it with a qEEG brain map)

- 180 Hours of our hybrid combined Berard and Tomatis Auditory Integration Training includes Audiograms (up to 8), 3  of Test of Auditory Processing Disorder, and 3 of Test of Auditory processing skills (before starting, after 90, and when finished) $7,995.00 (In children unable to do these tests, we will replace it with a qEEG brain map)

Auditory Integration Training using Tomatis Bone Conduction Headphones is conducted at the comfort of your own home 

Auditory Training requires equipment which will be supplied by us. There is a $400 deposit required, which will be refunded provided the equipment is returned undamaged within 14 days of stopping.

We will credit payments you have made for the Initial evaluation, Audiogram,  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.

 

Here is how packages work:  You are being charged our Standard Rate for the services you are receiving. Once the amount of services has equaled your package price, the remaining services are being offered as free until the end of the package.  If you do NOT complete your package (including if we decide to stop providing services to you), you will be charged the standard fees for the services. This will cause you to lose your discount but you are not paying any more than having no package. 

If you have paid by credit card, 6% will be deducted from any refund which is what we get charged for credit card processing (3% for the charge and another 3% for refunding) 


 

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

 

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

 

We are in-network with these and other providers to use TMS for the treatment of medication-resistant depression as listed above (some are now starting to cover medication-resistant OC as well) :

 

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.