2. Intake packet

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Once step 1 is completed we will contact you to schedule an intake appointment. And either we can send you the medical and medications history to be completed at your home computer or tablet, or you can come into the office to complete prior to the appointment (at least 30 min) 

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3. Schedule an intake appointment

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Please come 30 minutes early to complete paperwork. Please bring full current med list.

At this appointment, we will discuss your history and illness, review your medical history, and make sure that TMS is the clinically appropriate treatment for you.

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4. Treatment appointment

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If you meet the criteria for TMS treatment, we will begin the prior authorization process. Once your prior authorization is approved we will schedule your first mapping appointment.

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What is Transcranial Magnetic Stimulation?

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Transcranial Magnetic Stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain.

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It's FDA cleared to treat Major Depressive disorder. The treatment takes about 30 minutes and is done 5 days a week for 6 weeks.

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Most insurance covers this procedure if certain criteria is met.

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Goodwin Health Cafe can offer TMS to clients with the following insurance:

• Molina  

• Amerigroup  

• Chpw 

• Coordinated care 

• Premera 

• Aetna 

• Cigna 

• First choice 

• Tricare

• Assuris 

• Providence

• Out of Pocket

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The following insurances require a Physician or MD to order the TMS and therefore GOodwin Health Cafe is not able to offer TMS to: Medicare, Optum, United, GEHA

 

What kind of TMS machine does Goodwin Health Café use?

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We use a Blossom TMS device. It is FDA cleared to give repetitive TMS (rTMS) and can also do iTBS (intermittent theta burst Stimulation) but not fda cleared. It has a reclining chair with a massage function. The machine is quiet compared to other machines and uses a figure-8 coil that is placed against the head, and not around the head (like a helmet used in deep TMS).

 

What are common side effects and risks of TMS?

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The biggest side effect is the discomfort of the stimulation. It rests against the head and pulses magnetic stimulation that can feel like hard tapping on the head. Sessions are brief and the tapping only occurs for seconds at a time.

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The biggest risk for TMS is a TMS-induced Seizure.  This is very rare and may even be lower risk than some psychotropic medications. However, due to the risk, there is always someone in the room during treatment monitoring for signs and symptoms of a seizure. TMS seizures are self-limiting, and usually people recover quickly. It has not been linked with causing long term seizure disorders.

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The biggest contraindication is metal within 30cm of where the device is placed. Examples included a cochlear implant. Most dental implants are ok.

 

Does insurance cover TMS?

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Most insurance will cover TMS. Each insurance has its own rules, so looking up their policy may be helpful before getting started. Our TMS screener tries to encompass as many insurances as possible.

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Specifically for Goodwin Health Café, since we are a Nurse practitioner ran clinic, and do not have a physician on staff we are not able to bill Medicare, Optum, united and GEHA for this service, since they all require a physicians order. Most other private insurances and Medicaid are accepted by Goodwin Health Café.

 

Our machine, the blossom TMS is only FDA cleared for rTMS, which is the most used TMS procedure.  It lasts about 19 minutes, so the appointments will be about 30-40 minutes.  Other procedures like ITBS is possible with the blossom but not cleared, so we can’t bill your insurance for this even if your insurance pays for ITBS.  We are able to provide it if the patient opts for cash pay.

 

Who can receive TMS?

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The blossom TMS machine is FDA cleared to treat Major Depressive Disorder. Other machines have other indications (like OCD and Nicotine addiction).

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Insurance requires a Major Depressive disorder diagnosis. And requires several failed medications trials (2-4) often with medications with different chemical mechanisms (like an SSRI and SNRI and Wellbutrin, or an augmentation strategy). Our screening tool goes into more details with what different insurances require.

 

Many insurances require a 6 week trial of psychotherapy as well.

 

Insurance requires no contraindications like metal implant near where their device will be placed and history of seizure disorder. As well as pregnancy or breastfeeding.

 

Other contraindications most insurances want ruled out are: psychosis and psychotic disorder, current or recent substance use disorder, severe neurological conditions, significant cardiovascular disease (without cardiologist signing off)

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Most insurances won’t cover TMS in Bipolar disorder.

 

What is rTMS vs dTMS vs ITBS vs SAINT

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rTMS or repetitive TMS is the traditional 19-minute TMS series that is approved for major depressive disorder. Insurance tends to cover this the most and is offered at Goodwin Health Café.

 

dTMS or deep TMS is a form of tMS that uses a helmet rather then figure 8 coil.  Brainsway is the machine that uses this method.  At the time of this writing there are no Brainsway devices in Spokane, Wa.

 

ITBS or intermittent theta burst, is an accelerated TMS procedure. It only takes 3 minutes to complete. It tends to be more intense then rTMS. It has been found to be just as effective as rTMS. It is FDA cleared and many insurances are starting to cover this procedure. At this time Blossom TMS (our machine) can perform this procedure, but we can bill insurance for it.

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SAINT or Stanford Accelerated Intelligent Neuromodulation Therapy. Is a method of accelerated TMS. It essentially uses theta burst treatment (3 at a time) every hour, 10 hours a day for 5 days.  It also uses MRI imaging to identify the brain region to place the coil against.  This method is FDA cleared, but there is not a pathway for insurance to cover, nor really a machine that can do all that was done in the SAINT protocol or that got FDA clearance.  Many TMS companies mimic this by using 3 theta burst treatments hourly x 10 hours x 5 days.  This is only available for cash pay. But is likely the future of TMS since it offers and antidepressant effect in less then a week.