Medicare — TMS therapy in Anaheim

Medicare Part B covers outpatient psychiatric care for beneficiaries, including evaluation and management visits, medication management, and Transcranial Magnetic Stimulation for treatment-resistant depression. Medicare has no single national coverage policy for TMS. Coverage is set regionally by the Medicare Administrative Contractor (MAC) through a Local Coverage Determination (LCD). For California, the MAC is Noridian (Jurisdiction E), and its TMS policy is LCD L37086, which covers TMS for adults with major depressive disorder who meet its criteria. Medicare Advantage plans must cover at least what Original Medicare covers in their area.

What Medicare typically covers

• Adult psychiatry and medication management — evaluations, follow-ups, prescription oversight under Part B
• TMS therapy for FDA-cleared indications — major depressive disorder that has not responded to medication, under Noridian LCD L37086; other uses, including OCD, are not covered under that policy

Coverage detail differs between Original Medicare (Parts A and B) and Medicare Advantage (Part C). Advantage plans set their own networks, copays, and prior-authorization workflows but must cover at least what Original Medicare covers in their area.

Prior authorization for TMS

Original Medicare does not require prior authorization for most outpatient psychiatric services, but TMS is a higher-utilization specialty procedure and Medicare pays for it only when the criteria in the regional LCD are documented. Medicare Advantage plans generally do require prior authorization. Documentation typically required:

• Confirmed DSM-5 diagnosis of severe major depressive disorder, single or recurrent episode
• One of: no clinically significant response to antidepressant trials from at least two different medication classes in the current episode; intolerance to two trials from two different classes; a history of response to rTMS in a previous depressive episode; or current electroconvulsive therapy (ECT)
• Baseline severity score (PHQ-9, HAM-D, or equivalent)
• A trial of evidence-based psychotherapy for depression without significant improvement
• Treatment delivered by an FDA-cleared TMS device

Healing TMS Clinic uses FDA-cleared TMS devices.

Verifying your specific plan

Original Medicare beneficiaries should also check Medigap (supplemental) coverage for Part B coinsurance. Medicare Advantage members should verify the specific plan's TMS policy, since Advantage plans apply their own networks and authorization rules. Verify against your Medicare card or Advantage plan ID before scheduling.

Frequently asked questions

Is TMS therapy covered by Medicare? Yes, for adults with major depressive disorder who meet the criteria. Medicare has no national coverage policy for TMS; coverage is set by the regional Medicare Administrative Contractor. In California that is Noridian, under LCD L37086. Medicare Advantage plans must cover at least what Original Medicare covers in their area.

Does Medicare require prior authorization for TMS? Original Medicare does not require prior authorization for most outpatient psychiatric services, but TMS is a higher-utilization specialty procedure and Medicare pays for TMS only when the regional LCD's criteria are documented. Medicare Advantage plans generally do require prior authorization, applying their own networks and authorization rules.

How many antidepressants does Medicare require before approving TMS? Under Noridian LCD L37086, which covers California, one of the following must be documented: no clinically significant response to antidepressant trials from at least two different medication classes in the current episode; intolerance to two trials from two different classes; a history of response to rTMS in a previous depressive episode; or current electroconvulsive therapy (ECT). Documentation also includes a confirmed diagnosis of major depressive disorder, a trial of evidence-based psychotherapy without significant improvement, a baseline severity score such as PHQ-9 or HAM-D, and treatment delivered by an FDA-cleared TMS device.

Does Medicare Advantage or Medigap change my TMS coverage? Original Medicare beneficiaries should also check Medigap (supplemental) coverage for the Part B coinsurance. Medicare Advantage members should verify their specific plan's TMS policy, since Advantage plans apply their own networks, copays, and authorization rules. Verify against your Medicare card or Advantage plan ID before scheduling.

Verify Your Coverage

Not sure if your plan covers TMS at Healing TMS Clinic?

Send us your insurance card and date of birth via our secure verification form. Our team responds within 1 business day with the exact coverage, prior-authorization requirements, and your estimated out-of-pocket cost.

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Other services covered

• TMS Therapy
• Medication Management

About Healing TMS Clinic

Healing TMS Clinic is a psychiatric outpatient practice at 5475 East La Palma Avenue, Suite 204, Anaheim, CA 92807. We serve patients throughout Orange County, North Long Beach, the San Gabriel Valley, and the Inland Empire within a 30-mile radius. Call (657) 656-5611 to begin verification or to schedule a clinical consultation.

Related reading

• Medicare and TMS Coverage: What the LCDs Say — how Medicare covers TMS through regional Local Coverage Determinations, and how Medicare Advantage differs
• The Prior Authorization Process for TMS: A Step-by-Step Patient Walkthrough — the clinical criteria payers review, the documentation packet, and the typical 5–15 business-day timeline
• When TMS Is Denied: How the Appeals Process Works — why most denials are documentation gaps, and the three appeal levels that reverse them