When trying to determine insurance coverage for mental health treatment in the military, many people wonder, does TRICARE cover TMS Therapy. The answer is yes, Transcranial Magnetic Stimulation (TMS) is a covered benefit under TRICARE for eligible beneficiaries who meet specific clinical criteria.
TRICARE began covering TMS as part of its basic benefit package in 2016, recognizing it as an effective treatment option for patients with treatment-resistant Major Depressive Disorder. This coverage applies to active duty service members, military retirees, eligible family members, including spouses and children, and National Guard and Reserve members.
Because TMS is considered a limited benefit under TRICARE, prior authorization is required before beginning treatment using military insurance. While TRICARE covers TMS for Major Depressive Disorder, it does not currently cover the therapy for other conditions, such as PTSD, anxiety disorders, or concussion symptoms when these occur independently. However, coverage may apply when these conditions are present alongside MDD.
Who Qualifies for TRICARE-Covered TMS Therapy?
To qualify for TRICARE coverage of TMS therapy, veterans and active duty military insurance policyholders must meet all of the following criteria:
Medical Requirements:
- Be diagnosed with Major Depressive Disorder by a psychiatrist
- Have attempted at least four different antidepressant medications that did not work
- Be 18 years of age or older
Eligible Beneficiaries:
TRICARE coverage extends to:
- Active duty service members – all branches of the military
- Military retirees – those who have completed their service and retired from the military
- Family members – spouses and children of active duty or retired service members
- National Guard and Reserve members – and their eligible family members
Administrative Requirement:
- Prior authorization is required before beginning TMS treatment, as it is considered a limited benefit under TRICARE.
Which TRICARE Plans Include Mental Health Coverage for TMS Therapy?
All major TRICARE plans cover TMS therapy as part of their mental health benefits. Here’s the breakdown by plan:
TRICARE Plans That Cover TMS:
- TRICARE Prime
- A managed-care option where Military Treatment Facilities are the principal source of health care
- Requires a referral from your Primary Care Manager for specialty mental health services
- Typically has the lowest out-of-pocket costs
- TRICARE Select
- A fee-for-service option that offers more flexibility in choosing providers
- Does not require a referral to see specialists, including for TMS therapy
- Higher copayments compared to TRICARE Prime
- TRICARE For Life
- Provides supplementary health-care coverage for TRICARE beneficiaries 65 years old and older who are entitled to Medicare Part A and enrolled in Medicare Part B
- Offers coverage for mental health services, including TMS therapy
- TRICARE Reserve Select
- Available to certain members of the National Guard and Reserve
- Includes mental health coverage for TMS therapy
The cost patients pay depends on the TRICARE plan, whether their sponsor enlisted before or after January 1, 2018, and their status as active duty, retired, or family member. All TRICARE insurance plans for mental health include a variety of treatment options, such as inpatient care, outpatient therapy, prescription medications, and both group and family therapy, with TMS being part of the outpatient mental health benefit.
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Is TMS Covered by TRICARE for Veterans and Active-Duty Members?
TRICARE covers TMS therapy for active-duty members and military retirees who meet specific eligibility requirements. Active-duty members across all branches of the military can access TMS therapy as an outpatient treatment for Major Depressive Disorder when a psychiatrist has diagnosed them and has demonstrated treatment resistance by trying at least four different antidepressant medications without success.
Military retirees with TRICARE eligibility, whether through TRICARE Prime, TRICARE Select, or TRICARE For Life, also have access to this coverage under the same clinical criteria. The treatment is available as part of TRICARE’s mental health benefits package.
TRICARE coverage applies specifically to military retirees and active-duty personnel, not all veterans. Veterans who separated from military service without retiring typically receive their healthcare through the Department of Veterans Affairs system rather than TRICARE. VA coverage policies for TMS may differ from TRICARE’s guidelines.
How Does TMS Compare to Other TRICARE Mental Health Treatments?
TMS therapy stands apart from other TRICARE-covered mental health treatments in several significant ways. Unlike traditional antidepressant medications, TMS is a non-invasive, drug-free therapy that uses magnetic fields to stimulate specific nerve cells in the brain associated with mood regulation. This makes it particularly valuable for military members and their families who may wish to avoid medication side effects or reduce their dependence on pharmaceuticals.
TMS requires no anesthesia and does not necessitate hospitalization, with treatment sessions typically lasting only 20-30 minutes and allowing patients to resume normal activities immediately afterward. While conventional psychotherapy and medications remain the first-line treatments covered by TRICARE for depression, TMS is specifically reserved for patients with treatment-resistant Major Depressive Disorder.
The positioning of TMS within TRICARE’s mental health treatment hierarchy reflects its role as an advanced intervention for complex cases. TRICARE covers a comprehensive range of mental health services, including individual and group therapy, psychiatric consultations, inpatient hospitalization, and various medications as standard treatments. However, TMS is designated as a limited benefit requiring prior authorization, signaling that it is a specialized option after traditional approaches have proven insufficient.
Does Tricare Cover TMS Therapy? Key Takeaways
- TRICARE has covered Transcranial Magnetic Stimulation (TMS) therapy since May 2016 as part of its basic benefit package for treating Major Depressive Disorder.
- To qualify for TRICARE-covered TMS therapy, patients must be at least 18 years old, have a psychiatrist-confirmed diagnosis of Major Depressive Disorder, and demonstrate treatment resistance by having tried at least four different antidepressant medications without success.
- TRICARE currently does not cover other conditions, such as PTSD, anxiety disorders, or concussion symptoms when these occur independently.
- TMS therapy provides a non-invasive, medication-free treatment option that uses magnetic fields to stimulate brain regions associated with mood regulation.
- TRICARE benefits are available to military retirees and active-duty personnel, but veterans who separated from service without retiring typically receive care through the VA system instead.
If you’re curious about, does TRICARE cover TMS therapy, don’t hesitate to reach out to Moment of Clarity in Southern California at 949-625-0564 for detailed information on your mental health care coverage options. Our knowledgeable team can guide you through the specifics of what is covered and help you understand how TMS therapy may be a viable option for your treatment.
Resources
- Tricare.mil – Transcranial Magnetic Stimulation
- National Library of Medicine – Prefrontal transcranial magnetic stimulation for depression in US military veterans – A naturalistic cohort study in the veterans health administration
- U.S. Department of Veterans Affairs – Transcranial Magnetic Stimulation (TMS) – Treatment for Depression
