Southeastern Psychiatric Associates is here for your patients. Efficient collaboration is assured by the availability of our staff and providers, thereby enabling direct communication to the benefit of our patients.
Below you will find the basic criteria in which patients must meet to be covered by their insurance. If you feel your patient is fit for TMS and would like to refer them, please click the button below to complete the TMS referral form. You will be sent to a third party service which is confidential and HIPAA complaint.
From there, we will reach out to your patient about starting the TMS intake process. Providers are encouraged to be involved in each step of the way during their patient’s TMS treatment.
If you have any questions about the referall process, please feel free to call us at 781-963-7775 ext. 21 or email [email protected].
Please leave us any feedback by email. We value suggestions and criticism, as we strive to continuously develop and improve our processes.
We look forward to working together with you!
Transcranial Magnetic Stimulation Insurance Criteria
Please find below the basic criteria in which most insurances require patients’ to meet in order to be covered and to receive prior authorization for TMS:
BOTH OF THE FOLLOWING MUST BE MET:
- Must have a diagnosis of Major Depression (single or recurrent episode) as defined by the most recent Diagnostic and Statistical Manual (DSM)
AND
- A trial of evidenced-based psychotherapy know to be effective in the treatment of MDD of an adequate frequency and duration without significant improvements in depressive symptoms
AND
ONE OR MORE OF THE FOLLOWING:
- A lack of clinically significant response, in the depressive treatment episode, to three or four (dependent on insurance) trials, from at least two different agent classes, including at least one anti-depressant medication, administered at an adequate dose and duration of at least 4 or 6 weeks (dependent on insurance);
- Inability to tolerate psychopharmacologic agents as evidenced by failed trials of four such agents with distinct, documented side effects;
- History of response to rtms in a previous depressive episode;
- Currently receiving electroconvulsive therapy (ECT)
- Currently considering ECT; rtms may be considered as a less invasive treatment option
- Under 18 years of age
- Are pregnant
- Presence of an implanted magnetic-sensitive device located less than or equal to 30 cm from the TMS magnetic coil or other implanted metal items, not limited to:
- Cochlear implant
- Implanted cardiac defibrillator
- Pacemaker
- Vagus nerve stimulation
- Mental aneurysm clips, coils, staples, or stents
- Seizure disorder or any history of seizures (except those induced by ECT or isolated febrile seizures in infancy without subsequent treatment or recurrence)
- Neurological conditions that include epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, history of repetitive or severe head trauma, or primary or secondary tumors in the central nervous system
- Presence of acute or chronic psychotic symptoms or disorders in the current depressive episode
- Current active history of:
- Bipolar Disorder
- Eating Disorder
- Psychotic Disorder, including Schizoaffective Disorder
We accept most health plans from the insurances listed below. Be sure to call your insurance to confirm if Transcranial Magnetic Stimulation is covered under your plan.
- Tufts Health Plan
- Blue Cross Blue Shield
- United Health Care
- Cigna
- Optum
- United Behavioral Health
- Pacificare
- Harvard Pilgrim
- Medicare
If you do not have an insurance that covers Transcranial Magnetic Stimulation, some patients may have the option to pay out of pocket, if TMS is a good fit for you.
