Depression affects millions of Americans and can be particularly challenging when standard treatments like medications and talk therapy are not effective. Treatment resistant depression leads many patients at Shanti Wellness and Recovery to consider a well-researched, non-invasive alternative: Transcranial Magnetic Stimulation (TMS).
This treatment has become more commonplace over the past decade or so as research demonstrates the positive effects of magnetic stimulation of specific areas of the brain.
If you are living in Portland, are covered by Medicare, and are considering TMS, it is essential to understand how Medicare coverage works, what requirements you must meet, what costs you might face, and how Oregon providers handle the process.
Let’s dig into the policy and practical aspects of TMS coverage under Medicare in Oregon so you can be empowered with the information you need to make the best decision for your mental health.
First, What Is Transcranial Magnetic Stimulation (TMS)?
Transcranial Magnetic Stimulation is a medical treatment that uses electromagnetic fields to stimulate nerve cells in targeted areas of the brain involved in mood regulation. Unlike electroconvulsive therapy, TMS does not require anesthesia, sedation, or surgical implants. T Shanti Wellness and Recovery, treatment sessions typically last about 30 minutes or less. TMS patients come in for a quick, daily office visit for several weeks in an “outpatient” capacity.
TMS is FDA approved specifically for Major Depressive Disorder when other treatments have failed. It is not generally considered effective for other mental health conditions unless specific further approval is granted. For patients with Medicare, TMS coverage is focused on treatment-resistant depression. Unfortunately, Medicare does not generally cover TMS for generalized anxiety, post-traumatic stress disorder, or obsessive-compulsive disorder.
Original Medicare, Medicare Part B, and how TMS Coverage Works in Oregon
Medicare Parts A and B make up what is often referred to as “Original Medicare.”
Part B covers outpatient medical services, including physician-ordered procedures like TMS.
If you are enrolled in Original Medicare, TMS is covered only under Part B and only if certain criteria are met and the treatment is medically necessary.
Understanding the Two Things You’ll Need to Access TMS Coverage for Depression under Medicare in Oregon
In order to access coverage for TMS under Medicare, you’ll need two things:
1 – A formal diagnosis of severe Major Depressive Disorder from a psychiatrist or other qualified mental health professional.
2 – Symptoms of Major Depressive Disorder that have not responded adequately to prior treatments. You’ll sometimes hear this called “treatment-resistant MDD.”
Yes, Medicare requires documented evidence that you have already tried antidepressant medications and, in many cases, psychotherapy, without meaningful improvement. This documentation must show that these treatments were provided at appropriate doses and for sufficient durations.
Taken together, a formal MDD diagnosis and a history of symptoms that persist despite treatment form the basis of what’s called “medical necessity” for Medicare when it comes to TMS coverage.
Medicare Coverage for the Initial or “Acute” TMS Treatment Phase for Depression
At Shanti, we most often see Medicare coverage that includes a course of treatment lasting up to six weeks. This usually looks like 30−36 short sessions conducted during a very brief office visit, usually five days per week. This is known as an “acute” treatment phase. If Medicare will cover TMS for you, it will most likely cover this type of treatment.
Coverage beyond the “acute” treatment phase is more restrictive and generally requires new documentation showing that symptoms have returned and that the second course is medically justified.
Our Staff Will Help You Submit the Documentation You Need to Access TMS Treatment Through Medicare
At Shanti, we work with Medicare to submit records showing your diagnosis, history of prior treatments, treatment outcomes, and supporting clinical notes. We can help coordinate with your psychiatrist and/or primary care physician to assemble the documentation Medicare needs for approval. This teamwork can make the process smoother and improve the chances that Medicare will cover your treatment.
If Medicare denies coverage initially, you have the right to appeal that decision. Although appeals are rarely needed, we’re able to help with the additional documentation or clarification needed for an appeal, as well.
Costs for Depression TMS treatment You Should Expect as a Medicare Patient in Portland, Oregon
Medicare Part B only pays for outpatient procedures like TMS after you meet your annual deductible.
For 2026, most Medicare patients pay a monthly premium of $202.90 for Medicare Part B, although this premium is income-dependent and may be higher if your income is higher than average.
On top of the monthly premium, most beneficiaries have an annual Part B deductible of $283. This deductible must be met before Medicare’s 80% coverage for TMS treatment can begin.
Once your deductible is met, Medicare usually pays 80% of the Medicare-approved amount for each TMS session. This coverage means that you’re typically only responsible for the remaining 20% of the bill. This remaining 20% is referred to as “coinsurance.”
Supplemental Insurance Can Help Defray TMS Costs for Some of Our Portland Patients
Having supplemental insurance like a Medigap policy can significantly reduce your out-of-pocket costs for TMS treatment for MDD.
Medigap policies are designed to cover coinsurance and deductibles that Original Medicare does not pay. Some Medicare Advantage (Part C) plans also cover TMS and usually have different cost structures, but they must provide at least the same level of coverage as Original Medicare.
The details of which Medicare Advantage plans cover TMS and how much they pay vary. The specifics are outside the scope of this blog post, but looking into supplemental insurance can be a worthwhile investment for some patients at Shanti TMS.
Choosing a Medicare Friendly TMS Provider is a Smart Move in Portland and Throughout Oregon
Not all TMS providers in Portland accept Medicare assignment. That means the provider agrees to accept Medicare’s approved amount as full payment (minus your deductible and coinsurance). If a clinic does not accept assignment, you may face higher out-of-pocket costs or encounter billing complications.
Be Aware That There are Some TMS Treatments that Medicare Will NOT Cover in Oregon Under Any Circumstances
Medicare is very specific about what it will and will not cover when it comes to TMS.
Medicare TMS Coverage is almost entirely limited to patients with treatment-resistant Major Depressive Disorder.
Research has shown that TMS is useful for many other conditions and we serve patients with many different disorders and diagnoses at Shanti TMS. However, at this time, Medicare will not cover TMS when it is used for conditions such as:
- Generalized anxiety disorder
- Post-traumatic stress disorder
- Obsessive-compulsive disorder
- Smoking cessation
- Substance use disorders
Medicare has not approved TMS as “medically necessary” for these conditions under its current coverage guidelines.
If you want to access TMS for anything other than treatment-resistant depression, you will likely need to pursue that treatment without Medicare reimbursement unless Medicare policies change in the future.
Are “Maintenance” TMS Sessions Covered by Medicare in Oregon? Is TMS Medicare Coverage Ongoing?
Some Medicare plans will cover “maintenance” TMS sessions after the initial course of treatment, but many Medicare plans consider these sessions to be “investigational” and not “medically necessary.” This detail varies plan by plan.
Sometimes, Medicare will not cover maintenance TMS unless a new period of clinical depression is documented and meets the criteria again.
If they are covered, “maintenance” sessions often need separate approval. Often “maintenance” TMS sessions fall under different Medicare plan coverage rules than the TMS sessions that comprise the “acute treatment” phase. This means they’ll sometimes be covered, but will have different patient responsibility or coinsurance amounts.
Again, because these details vary so much plan-to-plan, you’ll need to check your specific Medicare plan for a better understanding of “maintenance” TMS coverage.
The Bottom Line? Don’t Let the Details Overwhelm You and Stop You From Reaching Out
If you struggle with treatment-resistant depression, Medicare coverage for Transcranial Magnetic Stimulation at Shanti TMS in Portland, Oregon can be a life-changing benefit.
So many of our patients cherish the relief from MDD they experience with TMS treatment, especially after medications and psychotherapy have just not delivered the results they need.
However, Medicare coverage for TMS is not automatic or universal. Coverage is tied to strict criteria, careful documentation, and compliance with regional Medicare rules.
You Focus on Feeling Better, and Let the Staff at Shanti TMS Handle the Rest
Knowing what Medicare covers and how TMS costs work can make your TMS treatment journey less overwhelming, but you don’t need to sweat the details alone.
At Shanti TMS, we work closely with your existing healthcare team to help ensure that your treatment is approved and that you fully understand your financial obligations before treatment ever begins.
Let us help keep track of all the details for you so that you can finally focus on your mental health and on finding the relief you deserve.
Medicare Coverage for Depression Treatment? Why Patients Choose Shanti TMS Over Corporate Providers
At Shanti TMS, we offer something many larger providers simply can’t: personal, consistent care delivered by a trusted local team. Patients who come to us from corporate TMS clinics often describe feeling like just another name on a schedule—rotated between locations, passed between unfamiliar staff, and left without a sense of continuity or connection.
We’ve built Shanti differently.
With one Portland location, a physician-led team, and a compassionate model of care, we prioritize trust, stability, and results.
Reach out for your free consultation today or give us a call at (503) 946-1227 and let us help you get your TMS journey started today.