Does Insurance Cover SAINT® TMS?

Insurance coverage for SAINT® depends on your specific plan, and it is handled differently from traditional TMS. Traditional TMS is billed under established CPT codes (90867, 90868, 90869) and has been covered by many commercial plans, Medicare, and the VA for years when medical-necessity criteria are met.

SAINT® is billed under Category III CPT codes (0889T–0892T). Category III codes are tracking codes for emerging technologies — they allow insurers to collect data on new procedures before establishing permanent coverage policies. Because these codes are newer, many plans have not yet established coverage policies for them, and some treat SAINT® as investigational.

The manufacturer, Magnus Medical, reports Medicare fee-for-service reimbursement and growing commercial coverage. However, coverage is not universal, prior authorization is common, and many patients currently self-pay. The only way to know your situation is to verify your specific plan.

Insurers may handle traditional TMS and accelerated protocols like SAINT® differently, even when both are FDA-cleared. Traditional TMS has a long track record of coverage under established codes. SAINT®'s Category III codes are newer, and each plan sets its own policy on whether to cover them.

Some plans cover SAINT® after prior authorization; others deny it as investigational or experimental. A plan that covers traditional TMS may not cover SAINT®, and vice versa. This is why benefits verification is essential before starting treatment — assumptions based on traditional TMS coverage do not necessarily apply to SAINT®.

Prior authorization is a clinical review in which your insurance plan decides, based on your medical records, that treatment appears medically necessary before approving it. Many plans require prior authorization for SAINT®.

Medical-necessity criteria typically include a diagnosis of major depressive disorder, documentation of prior antidepressant trials (including dose and duration), psychiatrist oversight, and the absence of exclusions. Your clinic submits this documentation, and the plan reviews it before treatment. If denied, you can request the reason, ask your psychiatrist about a peer-to-peer review, and file an appeal within the deadline.

Prior authorization is not a guarantee of payment. Even after authorization, a claim can be denied for coding, setting, or eligibility reasons.

These two terms are often confused, but they are different steps:

• Benefits verification — The clinic confirms your plan is active and asks whether the codes are covered, what your cost-sharing is, and whether authorization is needed.
• Prior authorization — A clinical review in which the plan decides, based on your records, that treatment appears medically necessary.

Neither guarantees payment. A claim can still be denied after treatment for coding, setting, or eligibility reasons. Benefits verification is a courtesy service that helps you understand your likely costs before starting treatment.

To verify your benefits, Neuro Wellness typically needs:

• Your insurance card (front and back) or member ID and group number
• Your date of birth and the policyholder's information if it is not you
• Basic clinical information (diagnosis and medication history) for prior authorization if required

The clinic contacts your insurance carrier, confirms current coverage, checks deductible status, and identifies authorization requirements. You receive a written estimate before treatment begins.

This is a common situation. The clinical eligibility criteria for SAINT® and traditional TMS overlap heavily, so most people who qualify for SAINT® also qualify for traditional TMS, which is covered under established codes when medical-necessity criteria are met.

If your plan denies SAINT® but covers traditional TMS, you have options. You can discuss the trade-offs with your psychiatrist: traditional TMS takes four to six weeks of daily visits, while SAINT® is five days but may require self-pay. You can also appeal the SAINT® denial — ask for the reason, request a peer-to-peer review, and file an appeal within the deadline.

Neuro Wellness offers both SAINT® and traditional TMS. Request a consultation to discuss which option fits your situation and coverage.

Neuro Wellness TMS Centers of America verifies your benefits at no cost and provides a written estimate before treatment begins. The clinic offers both SAINT® on the Magnus Neuromodulation System and traditional TMS, so if SAINT® is not covered by your plan, the clinical team can discuss traditional TMS as an alternative.

Coverage and benefits vary by plan and individual circumstances. Neuro Wellness can help patients verify their benefits but cannot guarantee coverage. To start the verification process, call 954-827-9793 or request a consultation online.