For coverage approval, typically health insurers require documentation to (which may vary by insurer) include:
- Adult age
- A diagnosis of Major Depressive Disorder (MDD), Moderate to Severe severity
- Validation and measurement of the diagnosis and depression severity using a standardized rating scale (commonly the PHQ-9, which mirrors the DSM criteria for MDD)
- Failure of 3 to 4 antidepressants during the current episode, with documentation of dosages, start & stop dates, and response to each
- Failure of a course of validated psychotherapy during the current episode
- Prior authorization from the insurer before starting
Initiating TMS Treatment
The process for initiating rTMS treatment typically includes:
- Gathering preliminary information on prior treatment trials and health status for safety and insurance approval
- Having in place releases of information to communicate with all medical and mental health providers for continuity of care.
- Performing an assessment to verify appropriateness and safety of treatment
Formulating a plan to manage any medical comorbidities, such as the existence of any implantable electrical devices or metal in the body
- The only firm contraindication to treatment with TMS is the presence of any ferromagnetically sensitive object in the head area.
- Obtaining informed consent for treatment, including a discussion of expectations and the known potential risks, side effects and benefits, including that effectiveness is not guaranteed
- The most medically concerning known side effect is the possibility of inducing seizures
Treatment typically requires:
- Commitment and dedication to your own recovery. Response, like many antidepressant treatments, is typically seen weeks into the stimulation.
- Daily transportation.
- Payment of associated fees and copays (our office will assist in clarifying this for you)
- Treatment is required almost every weekday for 9 weeks. This customarily includes 6 weeks of acute treatment 5 days per week, followed by a 3-week taper of thrice weekly for 1 week, twice weekly for one week, then once the last week.
- The first day of treatment lasts longer, because time must be taken to determine the motor threshold (MT) and map the appropriate treatment location
- Psychotropic medications are often maintained during and after treatment, especially of there has a been a partial response
- Near daily interaction with a, experienced, knowledgeable and supportive treatment team, and frequent monitoring by the administering physician, aids in safety and recovery