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 commercial health Plans and MediCare in California as a TMS provider.

TMS is a covered benefit under most insurance plans in California for Medication Resistant Depression. Although FDA has cleared TMS for OCD, Bi-Polar depression, and Smoking Cessation in recent years in addition to Medication Resistant Depression (2008), most insurance plans do not pay for these treatments using TMS at this time. 

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 from your doctors for insurance coverage. We will evaluate you and if TMS is the right treatment for you, we will make a request for authorization to your health plan.

As of 10-10-2020, here are the requirements from the major insurance companies for TMS coverage. We do offer treatment on a self-pay base 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, maximum of 5 a week while self-pay patients can do up to 5 sessions a day, 7 days a week. Typical course of treatment is 36 sessions for depression):

  1. Be 18 years or older
  2. Be diagnosed with severe major depressive disorder
  3. Must have tried 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. Patient must have tried antidepressants ( see the number below of how many by each insurance company) or 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, Tricare1 antidepressant 

United Healthcare (Optum): 4 antidepressant medications 

Kaiser: Kaiser does not cover any services at our San Ramon facilities. They might cover TMS in our Modesto Facilities. Contact us by telephone please. 

MediCal or County Health Plans: No coverage but we offer a discounted pricing. 

Tricare: 3 antidepressant medications + 1 augmentation

These requirements by the Insurance Companies are the same for all facilities in California.

 

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 receive services for 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 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:

​​

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

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.


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.


Neurofeedback and Auditory Integration Training is conducted at the comfort of your own home remotely

 

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

90 of our hybrid combined Berard and Tomatis Auditory Integration TrainingIncludes 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

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

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

Neurofeedback and Auditory Integration Training is conducted at the comfort of your own home remotely 

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.


 

Packages are discounted with the assumption of completing the 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 provided to you and the balance will be refunded.  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 on average (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.

 


There is a $150 charge for missed or canceled 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. 

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.