TMS Treatment and Medicare: What You Need to Know

TMS Treatment and Medicare: What You Need to Know

TMS Treatment and Medicare: What You Need to Know 150 150 Neuralia TMS
key points about medicare benefits schedule (mbs)
key points about medicare benefits schedule (mbs)

Medicare coverage for TMS is not automatic. Each case is assessed individually, and additional documentation from the treating physician may be required. Additionally, while out-of-pocket costs usually apply, depending on the specific provider and individual circumstances, this is not the case at Neuralia TMS. 

Neuralia TMS offers TMS therapy for depression at no additional cost to patients. This means that both standard TMS sessions and psychiatrist reviews are covered, effectively making the total cost of treatment $0 for eligible patients.

Book an Appointment at Neuralia TMS to get a better understanding of what costs may incur. 

TMS and Medicare Coverage

Transcranial magnetic stimulation (TMS) is a non-invasive treatment for major depressive disorder (MDD) that uses magnetic pulses to stimulate specific areas of the brain. According to a Harvard University study, TMS has shown promising results in individuals who haven’t responded adequately to traditional treatment methods like medication.

What is Medicare?

Medicare is the Australian government’s national health insurance program, designed to provide affordable and accessible healthcare to citizens and permanent residents. Here’s how it works:

What Medicare Covers

what medicare covers
what medicare covers
Treatment or ServiceDescription
Subsidised doctor’s visits and consultationsMedicare covers a portion of the cost for visits to general practitioners (GPs) and specialists.
Treatment in public hospitalsMedicare covers costs associated with treatment as a public patient in a public hospital, including surgery and emergency care.
Essential tests and scansThis includes services like x-rays, blood tests, and some pathology services.
Some allied health servicesMedicare may provide subsidies for services like physiotherapy and psychology under certain conditions.
Prescription medicationsMany prescription medicines are subsidised under the Pharmaceutical Benefits Scheme (PBS), which works in conjunction with Medicare.

Medicare is an important part of Australia’s healthcare system, providing peace of mind that essential health services are within reach for all Australians.

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Is TMS Covered by Medicare?

Medicare may cover TMS for severe MDD under specific conditions. The Australian Government Department of Health outlines these criteria, which include:

  • Formal diagnosis of severe MDD by a qualified psychiatrist
  • Failure to respond adequately to at least two different medications at appropriate dosages

What Does Medicare Cover for TMS?

Medicare Benefits Schedule (MBS) item numbers64100, 64101, 64102Depending on treatment duration
Treatment durationUp to 30 sessionsMBS currently reviewing extension requests
Out-of-pocket costsMay applyDepending on individual circumstances and private health insurance coverage

What is Medicare Benefits Schedule (MBS)?

The Medicare Benefits Schedule (MBS) is a list of health professional services that the Australian Government subsidises. It essentially acts as a reference guide for what medical services are covered under Medicare and the associated fees.

Here’s a breakdown of the key points about the MBS:

Medicare Benefits Schedule (MBS)

ContentA list of health professional services subsidised by the Australian Government. This includes consultations, diagnostic tests, and operations offered by various healthcare professionals like doctors, nurses, and allied health providers.
BenefitsProvides financial assistance to patients by reducing the cost of covered services. Patients typically pay a reduced fee or nothing at all, depending on factors like bulk billing.
ManagementManaged by the Australian Government Department of Health and accessible through their website, MBS Online. This website allows searching for specific services and their associated information.

Medicare coverage doesn’t guarantee complete financial coverage. While the MBS outlines the government’s subsidy, there might be additional out-of-pocket costs depending on the specific service, chosen provider, and individual circumstances.

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Insurance Companies that Cover TMS therapy

  • Aetna
  • Allianz
  • Bupa
  • Medibank
  • NIB

While Medicare coverage for TMS therapy in Australia is currently limited, many private health insurance companies do offer coverage for this treatment, but with varying degrees of accessibility and limitations.

Most major insurers like Aetna, Allianz, Bupa, Medibank, NIB may offer coverage for TMS, but often with strict criteria and limitations, such as requiring diagnosis of severe treatment-resistant depression and failed attempts at other treatment methods.

Coverage may also depend on your specific policy, the provider you choose, and out-of-pocket costs might still apply (e.g., co-pays, deductibles).

As of March 2023, Neuralia TMS is proud to be among the first multi-site TMS providers in Australia to offer a no out-of-pocket Medicare option for patients struggling with treatment-resistant depression. This means eligible patients will have full coverage for both TMS treatment sessions and TMS psychiatrist reviews through Medicare.

How Much Does TMS Cost in Australia?

So while Medicare may not cover the cost, there are several big insurance companies that can assist you. In Australia, typical TMS treatment costs range from $100 to $200 per session. Even with Medicare rebates, patients often incur out-of-pocket expenses between $20 and $100 per session. However, Neuralia TMS offers a unique depression treatment program in Perth where eligible patients can receive the entire treatment completely covered, eliminating any out-of-pocket costs. Visit our TMS costs page to find out more bout Medicare rebates. 

FAQs about TMS Treatment and Medicare

What are the requirements for TMS?

While specific requirements may vary, common criteria include being diagnosed with treatment-resistant depression (failing to respond to medication trials) and being at least 18 years old. A thorough medical and psychiatric evaluation is crucial to determine your suitability and identify any potential risks or contraindications.

Which TMS Therapy type is best?

There’s no single “best” type of TMS therapy, as each individual and their needs are unique. The two main types are repetitive TMS (rTMS) and theta-burst stimulation (TBS). rTMS offers more customization options but requires more sessions, while TBS is faster but has less flexibility. Choosing the right type involves consulting with a qualified healthcare professional who can assess your specific situation and recommend the most suitable approach.

Neuralia TMS are the Transcranial Magnetic Stimulation (TMS) specialists in Perth, WA. TMS is non-invasive treatment for depression and several other conditions.

Phone: 6230 3996
Email: [email protected]
Fax: 6230 2231
Healthlink ID: neuralia

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