Medicare

You'll need a confirmed diagnosis of severe MDD, along with documentation that one or more antidepressant medications haven't relieved your symptoms — or that you can't tolerate psychopharmacologic medications. TMS must be prescribed by a psychiatrist (MD or DO) who has examined you face-to-face and reviewed your mental health records.

Medicare covers daily outpatient TMS sessions for up to 6 weeks. It's covered specifically for MDD — Medicare does not currently cover TMS for other conditions, including OCD.

Medicare generally excludes TMS coverage for patients with implanted magnetic-sensitive devices (such as cochlear implants or cardiac defibrillators), a seizure disorder or history of seizures, or active psychotic symptoms during the current depressive episode.

TMS is billed under Medicare Part B. Once your annual Part B deductible is met, Medicare typically covers 80% of the approved amount per session, with a 20% coinsurance responsibility on your end.

Coverage generally requires a confirmed diagnosis of treatment-resistant depression — major depressive disorder with an inadequate response to two or more antidepressants.

Medicare Advantage plans typically require prior authorization before covering Spravato®. Your provider submits your treatment history, current medication trials, and clinical documentation supporting medical necessity.

Spravato® can only be administered at a clinic certified under the FDA's Risk Evaluation and Mitigation Strategy (REMS) program. Led Life LLC is a certified authorized SPRAVATO® provider.