Key takeaways
- Original Medicare coverage for TMS services in Florida is governed by First Coast’s local policy.
- Your diagnosis, medication history or intolerance, and psychiatrist’s evaluation matter.
- Medicare Advantage and Medigap serve different roles.
- Our team reviews your coverage and expected costs before treatment.
Original Medicare TMS requirements in Florida
First Coast’s LCD L34522 provides the local coverage framework.
| Coverage question | Florida Original Medicare summary |
|---|---|
| Population | Adults |
| Diagnosis | Severe major depressive disorder, single or recurrent episode |
| Medication history | One or more adequate failed medication trials and/or documented intolerance |
| Adequate trial | Dose and duration consistent with the medication’s labeling and an expected therapeutic response |
| Ordering clinician | Psychiatrist, MD or DO |
| Evaluation | Face-to-face examination and record review |
| Treatment setting/course | Outpatient treatment for up to six weeks |
| Psychotherapy or augmentation | Not separate initial requirements in the LCD |
| Symptom scale | No named scale or numerical cutoff mandated; clinical severity must be documented |
| OCD | Excluded |
| Repeat course | Individual medical-necessity review; no explicit fixed interval or response threshold in the cited Florida LCD/article |
Coverage question
Population
Adults
Diagnosis
Severe major depressive disorder, single or recurrent episode
Medication history
One or more adequate failed medication trials and/or documented intolerance
Adequate trial
Dose and duration consistent with the medication’s labeling and an expected therapeutic response
Ordering clinician
Psychiatrist, MD or DO
Evaluation
Face-to-face examination and record review
Treatment setting/course
Outpatient treatment for up to six weeks
Psychotherapy or augmentation
Not separate initial requirements in the LCD
Symptom scale
No named scale or numerical cutoff mandated; clinical severity must be documented
OCD
Excluded
Repeat course
Individual medical-necessity review; no explicit fixed interval or response threshold in the cited Florida LCD/article
A consultation also reviews treatment appropriateness and medical precautions. A diagnosis on an old record does not automatically establish that current coverage criteria are met.
Original Medicare, Medicare Advantage, and Medigap
| Coverage type | What it means for your review |
|---|---|
| Original Medicare | We apply the relevant Medicare coverage rules and documentation requirements. |
| Medicare Advantage | A private plan administers benefits. Applicable Medicare criteria still govern, with plan-specific network and authorization procedures. |
| Medigap | Supplemental insurance may help pay eligible Original Medicare cost sharing. It is different from Medicare Advantage. |
Coverage type
Original Medicare
We apply the relevant Medicare coverage rules and documentation requirements.
Medicare Advantage
A private plan administers benefits. Applicable Medicare criteria still govern, with plan-specific network and authorization procedures.
Medigap
Supplemental insurance may help pay eligible Original Medicare cost sharing. It is different from Medicare Advantage.
Bring both your Medicare information and any additional insurance cards. That helps us establish which coverage pays first and which benefits need verification.
What will TMS cost with Medicare?
For covered outpatient Part B care, patient coinsurance is commonly 20% of the Medicare-approved amount after the deductible, when the provider accepts assignment.
A supplement or other coverage may help with eligible cost sharing. Medicare Advantage costs depend on the plan’s benefits and network.
We estimate the cost of your proposed course using your actual coverage. The general Part B percentage is not an individualized treatment quote.
What documentation helps?
Our team reviews:
- Current psychiatric notes and symptom severity.
- Medication names, doses, dates, responses, and side effects.
- Relevant records from previous clinicians.
- Any prior TMS course and documented outcomes.
- Your current medications and medical history.
We arrange the psychiatric assessment and help organize the supporting record. If your plan has an authorization or other approval requirement, we explain the applicable process.
How we track your care
We use depression assessments and clinical follow-up to understand how you are doing. These measurements help document progress and guide clinical discussions.
We also coordinate with other treating clinicians when appropriate and with your consent. Tell us about changes in medications, symptoms, insurance, or the clinicians involved in your care.
Frequently asked questions
No single commercial insurer’s checklist should be assumed to apply. We use the governing Medicare framework and your documented clinical history.
The card may represent a Medicare Advantage plan or a supplement. Send us the complete information so we can identify the product and its role.
Contact us for a new evaluation. We review the applicable policy, previous treatment record, current symptoms, and medical necessity. We do not assume another Medicare region’s repeat-course rules apply in Florida.
No. A proposed maintenance schedule needs its own coverage review. Approval for an acute course does not establish coverage for every future schedule.
You can contact us first. We explain what information is useful and help identify the records needed for the review.
Provide all of your coverage information. Coordination of benefits and the order of payment can affect the review and your estimated responsibility.
Check your Medicare TMS coverage
Florida TMS Clinic provides TMS care in Wesley Chapel and Tampa. We can help you understand your benefits, the documentation needed, and the next step in the evaluation process.
Call (813) 867-2378 or request your Medicare coverage check.
View the full TMS insurance comparison.
Policy information checked November 1, 2026. Coverage depends on applicable Medicare rules, clinical circumstances, benefits, and any required approvals. Verification does not guarantee payment.
Official policy references
Medical information on this page is educational and not a substitute for professional advice. Individual results vary.