Insurance & Costs

We accept insurance for 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.

 

 Insurance Requirements to Cover TMS in California

We are In-Network with all major health Plans, Kaiser, 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 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 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 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 antidepressant medications + 1 augmentation

Anthem Blue Cross: 2 antidepressant medications

Beacon:  4 antidepressant medications 

Blue Shield (Magellan): 4 antidepressant medications 

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

Humana:1 antidepressant medication

Magellan:4 antidepressant medications

Medicare: 1 antidepressant 

Meritain:  4 antidepressant medications 

MHN:  4 antidepressant medications 

Optum: 4 antidepressant medications

TriCare/TriWest1 antidepressant medication

United:  4 antidepressant medications 

UMR: 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 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. 

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 which stops as soon as  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 $850.00 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?

 

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.

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

Service ( Please note many of these services are already included in the packages below) CPT Code Fee
1) Psychiatric Evaluation  (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
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
$1,750.00 *
 ( qEEG is included in most treatment packages) Patients doing 36 sessions of TMS receive $900 credit towards their insurance co-pays and deductible, making the cost of qEEG $850. 
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 $450.00
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 $350.00
14) Full Diagnostic Evaluation ( Suitable for ACT, SAT, LSAT, GMAT, Bar Exam, etc) Multiple Codes $4,500-$6,500

* qEEG cost is reduced for patients doing TMS with a $900 credit towards co-pays and deductibles. For example, if you have a $30 co-pay per visit, you pay $1,080 in co-pays. You paid $1,750 for a qEEG. You get a credit of $900 towards your co-pays, so $1080-$900= $180 which is what you will pay for your co-pay, so the total you paid is $1750+180= $1,930 for all your co-pays and your qEEG. For self-paying patients, qEEG is already included in most of our packages.

 

TMS Packages

 

 You can pay for each session of TMS which is: $400 per session.

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

 20 TMS Sessions Sampler(not enough for most patients, but should be able to see some improvements):

Include the initial evaluation, 1 qEEG Brain Map, 2 wellness visits during your TMS treatment, 1 motor threshold, for $5,995.00. 

 

- 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) for $7,500.00

We do not accept MediCal,  but a $1,000.00 discount is offered to anyone covered with MediCal 

 

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 Test of Mental Concentration, up to 3 CNS tests of memory, executive function, and processing speed (before you start and when finished) for $9,500.00

We do not accept MediCal, but a $1,500.00 discount is offered to anyone covered under these plans 

 

Additional Sessions after completion of a package (must start within 30 days of finishing a package): $175.00

 

​​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 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.

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. 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). No credit is given if some tests and assessments are not done.

 


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

 

Neurofeedback Packages

 

Neurofeedback sessions (typically 50 minutes) are $165.00 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. 

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 tests 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. We loan you the other equipment needed. There is a $400 security deposit which will be refunded assuming this equipment is returned undamaged within 14 days of stopping neurofeedback. There is a 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 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. 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). No credit is given if some tests and assessments are not done.

 


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:

15 Hours of our hybrid combined Berard and Tomatis Auditory Integration Training

Includes 1 Audiogram, 1 of  Test of Auditory Processing Disorder, and 1 Test of Auditory Processing skills $1,695.00

 

- 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 $2,995.00

 

- 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)

 

- 120 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)

 

150 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) $7,995.00 (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) $8,995.00

(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 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. 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). No credit is given if some tests and assessments are not done.


 

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