NHeLP says its fact sheet examines Medi-Cal coverage of TMS and recommends DHCS enforce coverage and access to the mental health benefit for patients.
NHeLP reviews Medi-Cal coverage questions
The National Health Law Program’s fact sheet, published October 4, 2024, describes transcranial magnetic stimulation as an evidence-based device and procedure used in the treatment of major depressive disorder. NHeLP says questions about Medi-Cal coverage for TMS have remained for a long time despite the treatment’s effectiveness and widespread use.
According to NHeLP, the fact sheet summarizes the history and evidence for TMS. It also reviews coverage status among Medicare, commercial plans in California, and Medicaid programs in other states. The organization says the document then describes the coverage status of TMS in Medi-Cal and the mechanisms through which Medi-Cal provides coverage for the service.
How NHeLP describes TMS treatment
NHeLP describes TMS as a procedure that does not require anesthesia. The source says it may be performed in an outpatient or inpatient setting by a psychiatrist, or by a TMS technician under the supervision of a psychiatrist.
The fact sheet states that a full course of repetitive TMS generally consists of 20 daily treatment sessions. According to NHeLP, each session generally lasts between 30 and 60 minutes.
NHeLP identifies major depressive disorder as the condition discussed in its description of TMS. The source does not present the procedure as a substitute for individualized assessment or treatment planning.
Evidence cited in the fact sheet
NHeLP cites a large National Institute of Mental Health-funded trial published in 2010. According to the fact sheet, 14% of patients with major depressive disorder achieved remission with TMS, compared with 5% of patients who received sham treatment.
The source further states that remission reached 30% among patients who continued treatment in an open-label extension of that trial. NHeLP includes this evidence as part of its broader review of TMS history, research, and coverage considerations.
Coverage and access recommendations
NHeLP says its fact sheet addresses Medi-Cal coverage status and the mechanisms used to provide coverage for TMS. The organization also provides recommendations for the California Department of Health Care Services, or DHCS, to enforce coverage of and access to what it describes as an important mental health benefit.
The fact sheet is not a statement that a new Medi-Cal policy has been enacted. Rather, NHeLP presents recommendations concerning enforcement of coverage and access.
What this means for California patients
For Californians trying to find TMS treatment locally, coverage questions may be part of the search process; the directory lists 382 published clinics in California.
This is general information, not medical advice.
More California reporting on access & coverage.
This report is educational and is not medical advice. Coverage, availability and eligibility can change; verify details with the named source or your care team.