The cost of depression treatment stops too many people from getting the care they need. If you or someone you love is living with major depressive disorder in Woodland Hills, Tarzana, Calabasas, or anywhere in the San Fernando Valley, this page will tell you exactly what your insurance covers, what you will pay out of pocket, and how to start.
Most major insurance plans cover TMS therapy. Medicare covers TMS for qualifying patients with severe major depressive disorder. The Iris TMS Wellness insurance team handles benefits verification, prior authorization, and billing directly, so you do not have to figure this out alone.
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Yes. Medicare covers TMS therapy for the treatment of severe major depressive disorder (MDD) when the treatment meets specific medical necessity criteria. Coverage is provided under Medicare Part B as an outpatient service.
Medicare TMS coverage applies to patients aged 65 and older who carry a confirmed diagnosis of severe MDD and who have not found adequate relief from antidepressant medication. Coverage includes daily outpatient TMS sessions for up to 6 weeks per treatment course.
Iris TMS Wellness accepts Medicare and works directly with patients and their care teams throughout the approval process.
Medicare Part B treats TMS as an outpatient medical service. Coverage includes:
Coverage applies at hospital outpatient settings and at qualifying freestanding outpatient TMS clinics. Iris TMS Wellness qualifies as an outpatient treatment setting for Medicare billing purposes.
Understanding your actual out-of-pocket cost makes the decision easier.
After meeting your $283 annual deductible, Medicare Part B pays 80% of the approved cost for each TMS session. You pay the remaining 20% as coinsurance.
Medicare Advantage Plans: If you have a Medicare Advantage (Part C) plan, your plan must cover TMS at least at the same level as Original Medicare. Out-of-pocket amounts vary by plan. Call your plan administrator or call Iris TMS Wellness; the team will check your specific Advantage plan benefits.
Medigap Supplemental Plans: Medigap policies can cover part or all of the 20% coinsurance that Medicare does not pay. If you carry a Medigap plan, your actual out-of-pocket cost for TMS may be $0 after your deductible is met.
The Iris TMS Wellness team reviews your specific Medicare or Medicare Advantage plan before your first appointment and tells you your exact expected cost.
Medicare TMS coverage requires meeting specific clinical criteria set by CMS. You must meet all of the following conditions to qualify.
Medicare requires a confirmed diagnosis of severe major depressive disorder (MDD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The diagnosis must be documented by a licensed physician (MD or DO) or a qualified clinical professional working under physician oversight.
TMS coverage does not currently extend under Medicare to anxiety disorders, OCD, PTSD, or chronic pain conditions as primary diagnoses, even though TMS may benefit these conditions clinically. Coverage is specifically tied to severe MDD.
To qualify, patients must have tried at least one course of antidepressant medication at an adequate dose and for an adequate duration without sufficient symptom relief. This is documented as a failed medication trial.
Patients who cannot tolerate antidepressant medications due to side effects also qualify, provided that intolerance is medically documented. The number of required failed trials can vary by Medicare Advantage plan; some plans require documentation of two or more failed trials before approving TMS.
Iris TMS Wellness’s clinical team assists with gathering and organizing this documentation. Patients do not need to prepare it on their own.
Certain medical conditions exclude a patient from Medicare TMS coverage. TMS is not covered if you have:
Patients with hip replacements, dental fillings, or metal implants located well below the neck are generally safe for TMS treatment. Dr. Elena Kapustina reviews each patient’s full medical history during the intake evaluation to confirm safety and eligibility before any treatment begins.
Yes. Most major commercial insurance plans in California cover TMS therapy for major depressive disorder when patients meet their plan’s criteria. Coverage requirements vary by carrier, but the standard threshold across most plans is a diagnosis of MDD combined with at least one failed antidepressant trial.
Iris TMS Wellness accepts TMS coverage from the following plans:
If your plan is not listed, contact Iris TMS Wellness. The team verifies coverage for plans not shown here and works with carriers to confirm TMS benefits on your behalf.
Most commercial insurance plans and all Medicare Advantage plans require prior authorization before TMS treatment can begin. Prior authorization means the insurance carrier reviews your clinical records and confirms that TMS is medically necessary for your specific case.
Documents typically required for prior authorization:
Iris TMS Wellness’s insurance team manages the entire prior authorization process. Staff submits documentation, responds to carrier requests, and tracks approval status. Most authorizations are resolved within 5 to 10 business days. Patients do not begin treatment until authorization is confirmed.
Your out-of-pocket cost depends on your insurance plan. Most patients with active coverage pay far less than the full self-pay rate.
Under Original Medicare Part B in 2026:
If you carry a Medigap supplemental plan, your coinsurance may be partially or fully covered. Some Medicare beneficiaries complete a full TMS course with $0 out-of-pocket costs after deductible, depending on their supplemental coverage.
Commercial plan costs vary based on your specific deductible, copay structure, and coinsurance rate. Typical patient scenarios:
Iris TMS Wellness provides a written cost estimate before treatment begins. There are no surprises.
Patients without insurance coverage can receive TMS therapy through Iris TMS Wellness’s self-pay program. Self-pay rates are discussed directly during the benefits consultation. Financing options are available for patients who need to spread out treatment costs over time.
Comparing TMS cost to ongoing medication costs is worth doing. A full TMS course is a one-time expense. Most patients who achieve remission do not need ongoing medication for 12 months or more after treatment ends. For many patients, TMS costs less over time than continued prescription management.
Step-by-Step Benefits Verification Process
Contact Iris TMS Wellness with your insurance card Call Iris TMS Wellness at (818) 805-2469 or submit your information through the online benefits form. Have your insurance card ready.
Iris TMS Wellness contacts your insurance carrier directly. The team confirms whether TMS is a covered benefit under your plan, what your deductible and coinsurance amounts are, and whether prior authorization is required.
Once coverage is confirmed, Iris TMS Wellness provides a written cost estimate showing exactly what Medicare or your commercial plan covers and what your out-of-pocket amount will be. You schedule your evaluation only after this step is complete.
Iris TMS Wellness serves TMS patients from across the San Fernando Valley, including Woodland Hills, Tarzana, West Hills, Calabasas, Canoga Park, and Encino. The clinic is located at 20300 Ventura Blvd, Suite 275, Woodland Hills, CA 91364, within 10 minutes of most surrounding communities.
Dr. Kapustina has direct experience with senior patients and Medicare-covered TMS treatment. Her clinical evaluations are thorough and patient-centered. Medicare patients at Iris TMS Wellness are not seen as administrative cases; they receive the same individualized attention as all other patients.
Many seniors take five or more prescription medications. TMS is drug-free. It does not interact with existing medications, which makes it a safe option for older adults with complex medication profiles.
TMS sessions are 20 to 40 minutes. Patients drive themselves to and from appointments. No sedation. No recovery period. The daily outpatient schedule works around other medical appointments and personal obligations.
Iris TMS Wellness manages Medicare prior authorization, billing, and documentation. Senior patients do not need to navigate Medicare paperwork on their own.
Yes. Medicare Part B covers TMS for patients with a diagnosis of severe major depressive disorder who have not responded to antidepressant medication. Coverage includes up to 6 weeks of daily outpatient sessions.
In 2026, Medicare Part B has a monthly premium of $202.90 and an annual deductible of $283. After meeting the deductible, you pay 20% coinsurance per session; Medicare pays 80%. If you have a Medigap plan, it may cover the 20% coinsurance, reducing your cost to $0.
Medicare covers up to 6 weeks of daily outpatient TMS sessions per treatment course. Sessions are typically five days per week, which means a standard course of 30 sessions is fully covered when medically necessary criteria are met.
Yes. Medicare Advantage plans must cover TMS at least at the same level as Original Medicare. Actual costs and prior authorization requirements vary by plan. Iris TMS Wellness verifies coverage for all Medicare Advantage plans.
Yes. Medicare requires TMS to be prescribed by a licensed psychiatrist (MD or DO). Iris TMS Wellness coordinates with prescribing psychiatrists as part of the TMS intake process.
Yes. Anthem Blue Cross and Blue Shield plans in California generally cover TMS for major depressive disorder when clinical criteria are met. Prior authorization is required. Iris TMS Wellness handles the authorization process.
Most insurance prior authorizations are completed within 5 to 10 business days. Iris TMS Wellness submits the required documentation and tracks the authorization on your behalf.
No. Treatment begins only after insurance authorization is confirmed. This protects patients from unexpected costs. Iris TMS Wellness moves quickly on authorizations to minimize any delay in starting your care.
Medicare does not currently cover TMS for anxiety, PTSD, or OCD as primary diagnoses. Some commercial insurance plans do cover TMS for these conditions in select circumstances. The Iris TMS Wellness team checks your specific plan’s coverage for all conditions during benefits verification.
Iris TMS Wellness’s team can assist with an appeal if your initial request is denied. Many initial denials are reversed on appeal when additional documentation is submitted. Self-pay options are also available if appeals are unsuccessful.