Yes, Medicare covers rTMS for adults with a major depressive disorder episode that has not improved after adequate trials of antidepressant medication. Coverage depends on meeting strict eligibility criteria.
Since 1 November 2021, repetitive transcranial magnetic stimulation has been listed on the Medicare Benefits Schedule, giving Australians a pathway to subsidised care. Around 14% of Australians are currently taking antidepressants, yet many do not respond to medication alone.
For eligible patients who meet the right criteria, Medicare can subsidise both the mapping appointment and subsequent rTMS sessions.
Medicare Eligibility Criteria for TMS
Medicare eligibility for rTMS is determined by a defined set of clinical, treatment-history, and provider conditions tied to MBS item 14216. Patients must meet every requirement before a rebate applies. A GP or psychiatrist referral starts the process.
Clinical Criteria You Must Meet
Each requirement must be formally assessed and recorded by a medical practitioner. Documentation showing that each clinical criterion is met is required before rTMS is considered clinically appropriate.
Without complete records, a claim under MBS item 14216 may not be supported. A GP or psychiatrist should compile the treatment history well before the rTMS assessment appointment.
To qualify:
- Patients must be at least 18 years old at the time of rTMS mapping under Item 14216.
- A current major depressive episode diagnosed under ICD-11 or DSM-5, with marked functional impairment lasting at least two weeks, must be confirmed.
- At least two different classes of antidepressants at a recommended therapeutic dose for a minimum of three weeks each must have been trialled without sufficient improvement.
- Each antidepressant dose must be titrated to the maximum tolerated therapeutic dose, where clinically appropriate.
- Psychological therapy must have been undertaken where this would reasonably be considered clinically appropriate.
- No prior history of transcranial magnetic stimulation therapy in any setting is permitted.
Please note: TMS is not suitable for patients with epilepsy or a history of seizures, or those with ferrous metal implants in the head or neck area. All patients are individually assessed for contraindications before treatment begins.
Referral and Provider Requirements
Item 14216 can only be claimed when delivered by a psychiatrist with verified rTMS training. Provider qualifications must meet standards endorsed by the Royal Australian and New Zealand College of Psychiatrists. A psychiatrist must maintain ongoing CPD in rTMS to retain eligibility to claim the item.
To qualify:
- Providers must accept a referral from a GP or another psychiatrist, unless an existing therapeutic relationship already exists with the rTMS psychiatrist providing Item 14216.
- For services performed personally by an rTMS-trained psychiatrist, the mapping and prescription component cannot be delegated.
- Training requirements endorsed by the Royal Australian and New Zealand College of Psychiatrists must be met and ongoing CPD in rTMS must be maintained.
- Providers must retain responsibility for prescribing the rTMS course delivered under related treatment items in the rTMS suite.
- Providers must certify in writing that hospital-based delivery is clinically required, as outpatient or consulting-room settings apply by default.
What is Not Covered by Medicare
Medicare rebates under Item 14216 do not apply in several clearly defined circumstances. Providers and patients should confirm eligibility before booking a mapping appointment.
The following circumstances fall outside Medicare coverage:
- Any patient with a history of transcranial magnetic stimulation therapy in public or private settings cannot claim Item 14216.
- A primary diagnosis other than a major depressive episode places the patient outside the item’s scope.
- Inadequate trialling of at least two different classes of antidepressants at therapeutic doses fails the medication history requirement.
- Adherence to antidepressant treatment must have been properly assessed, and medicines must not have been stopped before the minimum three-week duration.
- Psychological therapy must have been undertaken where reasonably considered appropriate, or the patient falls outside the item’s intended scope.
- Mapping performed by a clinician who has not met rTMS training and CPD obligations does not qualify for Item 14216 rebates.
- Stand-alone maintenance rTMS or courses delivered outside the initial and retreatment framework defined in the rTMS suite are not funded under Item 14216.
How Many TMS Sessions does Medicare Fund?
Medicare funds rTMS across four linked MBS items, covering both mapping and treatment delivery. The number of funded TMS sessions depends on whether a patient is completing an initial course or a retreatment course. Patients can check item details and co-claiming rules on the MBS online before their first appointment.
Medicare funds the following under the rTMS suite:
- Item 14216 covers prescription and treatment mapping for an initial course only, not the treatment sessions themselves.
- Delivery of the initial course falls under Item 14217, allowing up to 35 sessions, 3-5 times per week, for eligible patients.
- A retreatment course mapping and prescription is covered by Item 14219 when a patient has subsequently relapsed after responding to rTMS.
- Up to 15 maintenance sessions are funded under Item 14220 for the delivery of a retreatment course.
- On the same day an initial course begins, Items 14216 and 14217 may be billed together.
- Item 14219 can similarly be co-claimed with the first 14220 session when beginning a retreatment course.
- Both Items 14217 and 14220 may each be claimed more than once on the same day when multiple TMS sessions are clinically appropriate.
Step‑by‑step: How to Check if Your TMS Will Be Covered
Knowing whether rTMS is covered by Medicare comes down to preparation at two key appointments. Getting the right documentation from your GP and asking the right questions at your psychiatric assessment removes guesswork from the process.
Step 1: At Your GP Appointment
Ask your GP to document your major depressive episode, including how long it has lasted and the degree of functional impairment. Request a full list of every antidepressant you have trialled, covering the drug class and dose, and including duration.
Adherence to each medication and reasons for stopping must be recorded. Note any psychological therapies undertaken and ask your GP to record the clinical reasons if therapy was not pursued when it would typically be expected.
Step 2: At Your Psychiatric Assessment
Confirm with the clinic that the psychiatrist provides services under the rTMS item suite, including Item 14216. During the assessment, ask the psychiatrist to work through each Item 14216 criterion so you understand where you stand on diagnosis and treatment history. Ask the billing staff which MBS item numbers will appear on your Medicare statement.
Step 3: Confirm Your Costs
Check whether the mapping appointment will be billed as an outpatient or hospital service. An outpatient appointment attracts an 85% Medicare rebate, while a hospital service attracts a 75% rebate. Request a fee estimate for Item 14216 to calculate any out-of-pocket expenses before committing.
Next Steps if You Are Considering TMS
Moving forward with rTMS requires clear information from both your GP and psychiatrist. Understanding your Medicare options, treatment structure, and personal costs before starting puts you in a stronger position to make the right decision.
- Weigh clinical information from your GP and psychiatrist to determine whether rTMS under the Medicare item suite is appropriate at this stage.
- Clarify how an initial course and any retreatment course would be structured across Items 14216, 14217, 14219, and 14220 before committing.
- Ask your psychiatrist what clinical goals they expect from TMS treatment and how they will measure response or the need for retreatment.
- Discuss remaining medication or psychotherapy options to understand how rTMS fits alongside current treatments.
- Confirm whether mapping and TMS treatment will be bulk billed or charged above the schedule fee and how each option affects your costs.
- Based on clinical advice and Medicare eligibility, decide whether to proceed now or explore other funding options if the criteria are not met.
Neuralia TMS delivers repetitive transcranial magnetic stimulation for people whose symptoms have not adequately responded to antidepressant medication. Each person completes a detailed assessment followed by an individualised TMS treatment plan shaped by clinical history and current presentation.
As of March 2023, Neuralia TMS became Australia’s first multi-site TMS-specific service to offer a no out-of-pocket Medicare option for eligible patients. Treatment is coordinated alongside existing mental health support to maintain continuity throughout the programme.
Book a session with Neuralia TMS to discuss whether TMS therapy aligns with your current treatment goals.
FAQs on Is TMS Covered by Medicare Australia
Can I get rTMS in a public hospital without Item 14216?
Public hospitals may offer rTMS under state-funded or research programs. Access through those pathways is separate from Medicare rebates under Item 14216. All eligibility criteria still apply when claiming under Item 14216, regardless of the setting.
Does Private Health Insurance Help Pay for rTMS?
Private health insurance may cover some hospital and accommodation costs when rTMS is delivered as an inpatient service. Coverage rarely extends to the psychiatrist’s professional fees for rTMS sessions in a community setting. Checking directly with health insurance companies before starting treatment avoids unexpected out-of-pocket costs.
How do Doctors Decide When a Retreatment Course is Needed?
Clinicians typically consider retreatment when a patient previously responded to rTMS and has subsequently relapsed. A clear return of depressive symptoms, where other treatment adjustments have not produced satisfactory improvement, usually supports the case for retreatment. Your psychiatrist or GP makes the last call based on clinical presentation and treatment history.
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