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TMS Insurance Coverage in Colorado Springs
Most patients pay $0 out of pocket for TMS therapy. We manage all prior authorization, appeals, and billing — you make zero calls to your insurance company. No doctor referral required to start.
✓ No Doctor Referral Required · Call or submit the form below · We handle all prior authorization · Most patients pay $0
Plans We Accept
TMS is covered by most major insurance plans — and we handle every step of the process.
Since NeuroStar's FDA clearance in 2008, insurance coverage for TMS has expanded dramatically. Today, TRICARE, the VA, and all major commercial plans cover TMS when standard clinical criteria are met. We have never had a patient fill out a prior authorization form themselves.
Insurance Coverage Table
Verified as of 2025
| Insurance Plan | Coverage Status | Typical Out-of-Pocket | Auth Required |
|---|
| TRICARE Select | ✓ Covered | $0–small copay | Yes — we handle |
| TRICARE Prime | ✓ Covered | $0 most cases | Yes — we handle |
| VA Community Care | ✓ Covered | $0 most veterans | PCM referral + auth |
| Blue Cross Blue Shield | ✓ Covered | $0 after deductible | Yes — we handle |
| Aetna | ✓ Covered | $0 after deductible | Yes — we handle |
| Cigna / Evernorth | ✓ Covered | $0 after deductible | Yes — we handle |
| United Healthcare | ✓ Covered | $0 after deductible | Yes — we handle |
| Medicare Part B | ✓ Covered | 20% after Part B deductible | Yes — we handle |
| Medicaid Colorado | Verify | Call us to check | Call us to verify |
| Other Commercial | Varies | We verify before visit | Yes — we handle |
Coverage subject to individual plan terms and annual deductible status. Benefits verified at no charge before your first visit.
Coverage Criteria
What your insurance requires for TMS coverage.
Required
Primary MDD Diagnosis — A documented clinical diagnosis of Major Depressive Disorder (ICD-10 F32.x or F33.x).
Required
Prior Antidepressant Trial — Documentation of ≥1 antidepressant at adequate dose for ≥6–8 weeks without satisfactory improvement. Some plans require 2.
Not Required
Doctor Referral — You do not need a referral from your primary care doctor or psychiatrist to contact us. We initiate the evaluation process directly.
We Handle This
All Prior Authorization — We submit all documentation, track authorization status, follow up with your insurer, and appeal denials when warranted.
Our Authorization Process
1
We call your insuranceWithin 24 hours of your consultation request, we contact your insurer to confirm coverage details, deductible status, and exact cost-share.
2
We report back to youWe explain exactly what your plan covers, what you'll pay, and whether any additional documentation is needed — before you commit to anything.
3
We submit prior authorizationWe prepare and submit all clinical documentation. Most authorizations resolve in 5–10 business days. You receive a call when approved.
✓
You begin treatment — coveredOnce authorized, we schedule your first session. Sessions are billed directly to your insurer. Most patients receive an EOB showing $0 balance.
TRICARE & VA
TRICARE Group A (pre-2018 enlistment) — Lower annual deductibles. Most TMS patients pay $0 to minimal copay once the annual deductible is met.
TRICARE Group B (2018+ enlistment) — Higher annual deductibles. Cost-share depends on where you are in your benefit year.
VA Community Care — We are a registered VA Community Care provider. Ask your VA PCM to refer you to High Peaks TMS. Once referred, we manage everything. Most veterans pay $0.
Self-Pay & Financing
Transparent self-pay pricing is available for patients without insurance coverage or who prefer not to use insurance. Payment plans through CareCredit and other health financing programs available. FSA and HSA funds are eligible.
Call (719) 602-0622 to discuss self-pay rates. We do not publicize pricing online to prevent confusion with individual coverage differences.
Common Questions
Insurance questions, answered directly.
Do I need a doctor referral to start?
No. You do not need a referral from your primary care doctor or psychiatrist to contact us or schedule a consultation. We evaluate candidacy and begin the insurance verification process directly. A referral from your PCM is required only for VA Community Care patients — and we help you obtain that.
How long does prior authorization take?
Most commercial insurance authorizations are resolved within 5–10 business days. TRICARE and VA authorizations may take somewhat longer. We monitor authorization status proactively and notify you immediately upon approval. You receive a follow-up call with your authorization number and scheduled start date.
What if my insurance denies the prior authorization?
A denial is not final. We file a first-level appeal on your behalf with supporting clinical documentation. Many first-level appeals succeed. If the appeal is unsuccessful, we discuss self-pay pricing, CareCredit financing, and FSA/HSA options. We have not encountered a legitimate TMS candidate whom we could not help find a path to treatment.
What is my cost if I have a high-deductible plan?
If your deductible has not yet been met for the year, you may owe a portion of the TMS cost until your deductible is satisfied — after which your plan pays its share. We explain your exact deductible status and projected out-of-pocket cost before any treatment is scheduled. Many patients begin TMS early in the year when deductibles have already been met through other healthcare spending.
Is retreatment covered if depression returns?
Yes. Most plans — including TRICARE and the VA — will cover retreatment if depression symptoms return following a successful prior TMS course. A prior response to TMS strengthens the new authorization request. We manage retreatment authorization the same way we handle the initial course.
Does Medicare cover TMS?
Yes. Medicare Part B covers TMS for beneficiaries with a documented MDD diagnosis and at least one prior antidepressant trial without adequate improvement. After the annual Part B deductible is met, Medicare covers 80% of the approved amount. Your 20% coinsurance may be covered by a Medigap supplemental plan, reducing your out-of-pocket cost to zero in many cases.
Can I use an FSA or HSA for TMS?
Yes. TMS is a qualified medical expense eligible for Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA). Pre-tax dollars in these accounts can be applied toward any self-pay cost, annual deductible, or cost-share amount. This can significantly reduce your effective out-of-pocket cost.
What do I need to bring to the insurance verification call?
Nothing — we call your insurance company, not you. To help us verify faster, it helps to have your insurance card and member ID available when we call you back with results. The verification call takes approximately 20–30 minutes on our end and usually produces a definitive answer within 24 hours of your consultation request.
Verify My Coverage
Start with a free insurance verification — no commitment.
Call us or fill out the consultation form. We verify your specific TMS benefits and report back before your first visit. No charge. No obligation. No doctor referral needed.
(719) 602-0622
Monday–Friday 7:30 AM – 5:00 PM
No Doctor Referral Required
Call, text, or submit the contact form. Our team responds within 2 business hours. If you are a TRICARE or VA patient, see our veterans page for referral-specific guidance.
What You'll Learn From a Verification Call
- ✓Whether your specific plan covers TMS and under what criteria
- ✓Your exact annual deductible, how much is met, and your out-of-pocket projection
- ✓Whether prior authorization is required and how long it typically takes
- ✓What clinical documentation we need from you or your existing providers
- ✓Whether a VA Community Care referral is required (TRICARE patients)
- ✓Your start date once authorization is approved