Medicaid For TMS 2024

TMS Therapy Covered By Medicaid in 2024: Mental Health Access for Adults in CA

As of August 1, 2024, California’s Medicaid program, Medi-Cal,and Cal Optima in Orange County  has expanded its coverage to include transcranial magnetic stimulation (TMS) therapy for major depressive disorder (MDD), marking a significant advancement in mental health care accessibility. Medi-Cal’s inclusion of TMS therapy is a major breakthrough for depression treatment in California. Medi-Cal is the state’s Medicaid healthcare program, offering no-cost and low-cost health coverage to 14.8 million Californians, including adults with limited income and resources. With this update, adults diagnosed with MDD now have access to TMS, a non-invasive treatment that has shown great promise in reducing symptoms of MDD, especially for those who haven’t found success with traditional antidepressants or psychotherapy.

What Is TMS Therapy?

TMS uses magnetic pulses to stimulate specific areas of the brain involved in mood regulation. It’s a non-invasive, FDA-approved treatment that does not require sedation or anesthesia, making it a safe and well-tolerated option for many individuals. Typically administered in a series of daily sessions, TMS has minimal side effects, with the most common being mild headaches or scalp discomfort.

At A Better Way, we specialize in providing TMS using cutting-edge technologies designed for adult patients. Our focus is on helping adults manage their health more effectively, offering a targeted approach to treatment that can be personalized to each individual’s needs.

Medicaid / Medi-Cal’s New Insurance Coverage Includes TMS Treatment for Depression

The new Medi-Cal policy covers TMS under specific CPT codes, ensuring that patients receive comprehensive care throughout their treatment journey:

  • 90867: Initial therapeutic repetitive TMS treatment, including cortical mapping, motor threshold determination, delivery, and management.
  • 90868: Subsequent therapeutic repetitive TMS treatment delivery and management, per session.
  • 90869: Maintenance sessions necessary to sustain the benefits of TMS.

This policy expansion makes TMS therapy more accessible as a treatment option to millions of Californians who may have previously been unable to afford this care.

The Role of Industry Advancements in Mental Health

While this policy change is beneficial to a wide range of patients, it’s important to note that much of the recent attention has focused on TMS devices like those produced by Neuronetics, Inc., a leader in the field of neurohealth technology. Neuronetics recently received FDA clearance for its NeuroStar TMS system as a first-line add-on treatment for adolescents aged 15-21 with MDD. This expansion in coverage is part of a broader effort by the company to increase access to TMS, not just for adolescents but for adults as well.

Although A Better Way does not utilize NeuroStar devices specifically, we are proud to offer other FDA-approved TMS technologies that are equally effective for adult patients. Our commitment is to provide the highest quality care for adults seeking relief from depression through innovative, evidence-based treatments.

Why Expansion of Access to TMS Therapy Matters

Depression is a major public health issue, with millions of adults in the U.S. affected by the condition. According to the National Institute of Mental Health (NIMH), around 21 million adults experienced a major depressive episode in 2020. Unfortunately, many of these individuals do not respond to traditional treatments like antidepressants, leaving them in search of alternatives.

TMS has been shown to produce significant improvements in depressive symptoms, with clinical trials indicating response rates as high as 58% and remission rates around 37% for those who have not benefited from other treatments. With Medi-Cal now covering TMS, more adults can access this promising treatment option without the financial burden that previously limited its availability.

Take the Next Step: Schedule a Free Consultation

At A Better Way, we are dedicated to providing compassionate, comprehensive cognitive health care tailored to the needs of adults. With Medi-Cal now covering TMS, we can extend our services to even more individuals in California who are seeking effective treatment for depression.

If you or someone you love is struggling with depression and interested in exploring TMS therapy, we invite you to contact us today to schedule a free consultation. Let our experienced team guide you through the process, help you determine if TMS is the right choice for your needs, and build a personalized plan of care.

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