Insurance & Costs

Prices and Insurance Coverage

Insurance is accepted for the treatment of Medication-Resistant Depression using TMS 

 

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 for all other services

 

 Insurance Requirements to Cover TMS in California

We are In-Network with all major health Plans including and MediCare

For TMS Only

WE DO NOT ACCEPT INSURANCE FOR ANY SERVICE EXCEPT TMS

 

 

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 for 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 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 6 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:  4 antidepressant medications 

Blue Shield (Magellan): 4 antidepressant medications 

Cigna2 antidepressants from 2 different classes (e.g., both can't be SSRI's)

Humana: 1 antidepressant 

Magellan:4 antidepressants 

Medicare: 1 antidepressant 

Meritain:  4 antidepressants 

MHN:  4 antidepressants

Optum: 4 antidepressants 

TriCare/TriWest1 antidepressant 

United:  4 antidepressants  

UMR: 4 antidepressants 

MediCal: NO COVERAGE 

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 in-network with almost all health plans in California for TMS.

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 courses of TMS.  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.

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.  (These are always included on self-pay packages)

We believe that qEEG Brain Mapping helps to reduce the remote possibility of a seizure ( one in 30,000 treatments has resulted in a transient seizure during treatment). 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 $995.00 instead of $1,995 but conditioned on completing 36 TMS sessions. If, for any reason, regardless of the reason, 36 TMS sessions are not completed, then this discount is lost, and the full price applies.  (These are always included on self-pay packages)

 

HOW MUCH DOES IT COST WITHOUT INSURANCE?

 

Each session of TMS is $400. 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  session 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 12-01-2022 (prices are subject to change without notice):

Service ( Please note many of these services are already included in the packages below) CPT Code Fee
1) Psychiatric Evaluation for TMS candidacy, which includes face-to-face or Tele-Video meeting,  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
$1,995.00 * 
This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages. $995.00 for TMS patients using insurance to pay for their TMS treatments
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 $225.00 (This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages.
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 $375.00 ( This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages.
5) Wellness check (weekly while doing TMS)  CPT 99213 $200.00 ( This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages.) 
6) Motor Threshold to determine how much magnetic stimulation is required CPT 90869 $250.00 ( This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages.
7) Initial Consultation meeting with our Center Director ( not a diagnostic evaluation) CPT V68.20 $195.00 ( This is Included for patients that are paying out-of-pocket (cash pay) for TMS and Neurofeedback packages.
8) TMS Session (please see discounted package below) CPT 90868 $400.00 (Can cost as low as $180 in TMS packages)
9) Neurofeedback or tDCS Session (see discounted packages below) CPT 90901 $165.00 (Can cost as low as $75 in Neurofeedback Packages)
10) Auditory Training per hour (see discounted packages below) CPT 90901 $150.00 (Can cost as low as $80 in Auditory packages)
11) Auditory Processing Skills Assessment compared to similar age population CPT 96138 $450.00 ( This is Included for patients that are paying out-of-pocket (cash pay) for Auditory Training packages. 
12) ADHD Diagnosis (Includes services listed above 1,2,3,4, symptoms rating forms, and review of records) Multiple Codes $2,950.00 ( $2,000 of this can be applied towards any Neurofeedback or TMS Packages)
13) 504 School or Work accommodations in accordance with Americans with Disabilities after diagnostic services or completing forms for accommodations or disability with schools or Social Security   Multiple Codes $350.00
14) Full Diagnostic Evaluation ( Suitable for ACT, SAT, LSAT, GMAT, Bar Exam, etc.) Multiple Codes $4,500-$6,500

 

We can check your insurance plan's coverage criteria and fee schedules.

The only service we accept insurance for is the Treatment of Medication Resistant Depression in accordance with the insurance plan's criteria and after prior authorization has been approved. 

 

 

TMS Packages

We charge as little as $225.00 for each TMS session in packages of 36 sessions, as listed below.

What if you do not want to start and commit to a package?  That is not a problem because you can start by paying for the services you are receiving per session basis.  Once your total amount paid is equal to a package,  you are automatically converted to that package, which means you receive the discounted rate as if you had started with that package from the beginning.

You can for each service as you go without needing to commit to a package.

You can elect to have your payments credited to a package before your 9th session. This way, you enjoy the benefit of lower package pricing anyway.

We offer significantly discounted pricing for our self-paying clients, as outlined below. 

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). $5,995.00

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). $7,995.00

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). $9,995.00

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 then your insurance plan does authorize your TMS treatment, you will receive the discounted pricing offered to TMS clients ($995 for a qEEG brain map instead of $1,995 provided you complete 36 sessions). Over-payments are applied towards your deductibles or co-pays and any over-payment 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), two (2) CNS tests of memory, executive function, and processing speed. $3,995.00 ( 2 Month FREE online access fee is included, additional monthly online access fee of $125 after 2 months). 

 

  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 tests.

 

 

- 45 Neurofeedback Sessions

Include the initial evaluation, one (1) qEEG Brain Map, two (2) IVA Tests of Mental Concentration, two (2) CNS tests of memory, executive function, and processing speed (before you start and when finished)  $4,995.00 (3-months FREE online access fee is included, additional monthly online access fee of $125 after 3 months) 

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 evaluation, qEEG Brain Mapping, CNS, and IVA toward the packages that include them, provided you start within 30 days of those tests.

 

65 Neurofeedback Sessions 

sessions which include the initial evaluation, two (2) qEEG Brain Map, up to three  (3)  four IVA Tests of Mental Concentration, up to three (3) CNS tests of memory, executive function, and processing speed (before you start, midway and when finished)  $6,995.00 (5-months FREE online access fee is included, additional monthly online access fee of $125 after 5 months ) 

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 evaluation, qEEG Brain Mapping, CNS, and IVA toward the packages that include them, provided you start within 30 days of those tests.

 

95 Neurofeedback Sessions

Includes the initial evaluation,  up to three (3) qEEG Brain Map,   up to three (3)  IVA Tests of Mental Concentration, up to three (3) CNS tests of memory, executive function, and processing speed (before you start, midway and when finished)  $8,995.00 (5-months FREE online access fee is included, additional monthly online access fee of $125 after 8 months ) 

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 tests.

 

Family Discount: 

An additional person from the same family doing the same (or less) number of sessions as the primary client. This person will get  two (2)  qEEG Brain Maps, up to three (3) IVA Tests of Mental Concentration, and up to three  (3) CNS tests of memory, executive function, and processing speed ( before you start and when finished)  $ 3,995.00

 

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 tests.

*Home training program requires an Ipad or a Tablet which you need to provide. We will loan you the other equipment needed. There is a $300 security deposit which will be refunded if this equipment is returned undamaged within 14 days of stopping neurofeedback. 

 

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 tests.

 

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.

(prices are subject to change without notice)


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

 

Auditory Integration Training

 

Auditory integration training can be provided at our offices or at home. The hourly rate for this service is $150 for in-office services. We do offer significantly discounted prices for at-home training as outlined below:

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.

Autistic children with no speech and an inability to do auditory testing get tested using qEEG brain mapping. 

180 Hours $5,995 including 2 qEEG brain Maps ( you pay for a 90-hour package but will get an additional 90 hours for free.)

 

 

- 30 hours of our hybrid combined Berard and Tomatis Auditory Integration Training 

Includes 2 Audiometric, 2 SCAN (Test of Auditory Processing Disorder), and 2 TAPS ( Test of Auditory Processing Skills ) $2,995.00

You can upgrade to a larger package within 14 days of finishing a smaller package ( if you used the testing at the end of this package, then you need to add $450.00 to the upgrade price)

 

60 hours of our hybrid combined Berard and Tomatis Auditory Integration Training 

Up to 4 Audiometric, 2 SCAN (Test of Auditory Processing Disorder), and 2 TAPS ( Test of Auditory Processing Skills ) $4,995.00

(In children unable to do these tests, we will replace it with a qEEG brain map)

You can upgrade to a larger package within 14 days of finishing a smaller package ( if you used the testing at the end of this package, then you need to add $450.00 to the upgrade price)

 

90 of our hybrid combined Berard and Tomatis Auditory Integration Training 

Up to 6 Audiometric, 2 SCAN (Test of Auditory Processing Disorder) and 2 TAPS ( Test of Auditory Processing Skills )$5,995.00

(In children unable to do these tests, we will replace it with a qEEG brain map)

You can upgrade to a larger package within 14 days of finishing a smaller package. Everyone will get re-tested at this point.

 

 

120 hours of our hybrid combined Berard and Tomatis Auditory Integration Training

Up to 6 Audiometric, 2 SCAN (Test of Auditory Processing Disorder)  and 2 TAPS ( Test of Auditory Processing Skills ) $6,995.00

(In children unable to do these tests, we will replace it with a qEEG brain map)

You can upgrade to a larger package within 14 days of finishing a smaller package ( if you used the testing at the end of this package, then you need to add $450.00 to the upgrade price)

 

 

150 hours of our hybrid combined Berard and Tomatis Auditory Integration Training

Up to 6 Audiometric, 2 SCAN (Test of Auditory Processing Disorder)  and 2 TAPS ( Test of Auditory Processing Skills ) $7,995.00

(In children unable to do these tests, we will replace it with a qEEG brain map)

You can upgrade to a larger package within 14 days of finishing a smaller package ( if you used the testing at the end of this package, then you need to add $450.00 to the upgrade price)

 

 

180 hours of our hybrid combined Berard, and Tomatis Auditory Integration Training 

Up to 6 Audiometric, 3 SCAN (Test of Auditory Processing Disorder), and 3 TAPS ( Test of Auditory Processing Skills ) $8,995.00

(In children unable to do these tests, we will replace it with a qEEG brain map)

  

Autistic children with no speech and an inability to do auditory testing get tested using qEEG brain mapping. 

180 Hours $5,995 including 2 qEEG brain Maps ( you pay for a 90-hour package but will get an additional 90 hours for free.)

 

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.

 

 

(prices are subject to change without notice)

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.

Most insurance plans will not reimburse for Neurofeedback, qEEG Brain Mapping, or Auditory Training. 

TMS for treatment of medication-resistant major depression in adults will be covered only with prior written authorization( Except Medicare which does not require prior written authorization). 


 

There is no 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.  

 

There is a $175 charge for missed appointments not canceled at least 24 hours in advance.
 
 
We ARE NOT a MediCal or County plan affiliate.

These are some of the insurance companies we are in-network with as a TMS provider:

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.