Does Medicare cover TMS?
Yes. Medicare Part B covers TMS for treatment-resistant depression. It’s been this way since 2013 on a case-by-case basis, and by 2018 most Medicare Administrative Contractor (MAC) regions made it a standard benefit.
Short version: if you have Medicare and depression that hasn’t responded to medication, TMS is on the table.
What Medicare requires
To get approved, you’ll typically need:
- A diagnosis of Major Depressive Disorder (MDD) confirmed by a psychiatrist
- 2-4 failed antidepressant trials from different drug classes, each taken at a real dose for 6-8 weeks
- Prior authorization — your TMS clinic sends documentation to your MAC
- A supervising physician who orders and oversees your treatment
The exact criteria shift a little depending on your MAC region. Your TMS clinic will know what your area requires. That’s literally their job.
What you’ll pay
Under Original Medicare (Part B):
- Medicare covers 80% of the approved amount
- You cover 20% coinsurance after your annual Part B deductible ($240 in 2026)
- For a full 36-session course, expect roughly $1,200-$2,400 out of pocket depending on what the clinic bills
Got a Medigap supplement like Plan F or G? It may pick up some or all of that 20%.
Medicare Advantage (Part C) is a different story. Many MA plans cover TMS, but some pile on extra precertification steps or cap your sessions. Call your plan before you schedule anything.
How to get approved
- Your psychiatrist documents your diagnosis and every medication that didn’t work
- The TMS clinic submits a prior authorization request with all the paperwork
- Medicare usually responds in 1-2 weeks
- Most solid, well-documented requests get approved
Denied? You can appeal. The most common reasons are thin documentation of failed meds or incomplete records — fixable stuff. Your clinic can help with the appeal. They do this all the time.
Finding Medicare-accepting TMS clinics
Use our directory and filter by “Medicare” under insurance. One thing to watch for: not every TMS clinic accepts Medicare assignment. Some charge above Medicare’s approved rate, which means a bigger bill for you. Before you schedule, ask the clinic directly: “Do you accept Medicare assignment?”
That one question can save you hundreds of dollars.
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How to Get TMS Approved
Call the number on the back of your insurance card and ask specifically about TMS therapy coverage. Get a reference number.
Gather records of your MDD diagnosis, all medication trials (names, doses, durations, outcomes), current PHQ-9 score, and therapy history.
Find an in-network TMS provider using our clinic directory. In-network clinics handle prior auth and know your insurer's requirements.
Your TMS clinic submits the prior auth request. Typical approval takes 5-15 business days. If denied, appeal — overturn rates are 60-70%.
What If You’re Denied?
Don't give up after a denial
TMS denial overturn rates are 60-70% on appeal. Steps to take:
- Request a peer-to-peer review — your psychiatrist talks directly to the insurer's medical director
- Submit additional documentation addressing the specific denial reason
- File a formal appeal with your state insurance department if internal appeals fail
- External review — most states allow independent external review of coverage denials
For more details, see our Prior Authorization Guide and Denied Coverage Appeals guide.