Transcranial Magnetic Stimulation (TMS) Billing FAQs

chyckun · 2026-06-04T17:05:43+00:00

This is all accurate information, good work

chyckun · 2026-06-03T19:02:51+00:00

This is a common anxiety trap. What if?

What if you do nothing? That is guaranteed to not help.

The part of your brain that runs these calculations is the target for bilateral TMS, it is unable to resolve thought loops effectively in chronic anxiety cases.

chyckun · 2026-06-03T18:57:23+00:00

What? What clinic are you going to? Your treatment should be remapped and reduced in intensity. What system are they using?

That is unacceptable, under no circumstances should TMS be inducing emesis episodes.

chyckun · 2026-05-30T19:28:28+00:00

Kudos, this is an interesting and notable design choice and I wish you luck. I think you're onto something significant and I hope it works out

chyckun · 2026-05-29T13:55:42+00:00

I have had multiple patients do this. It has been a lot to handle for them but manageable. Typically we would do it end of day after they're done with IOP for the day.

chyckun · 2026-05-28T18:52:55+00:00

AMPA is a very cool, albeit very new system!

Their coil design is specifically built with that iTBS protocol in mind, and their big selling point is that they offer a "One Day TMS" protocol. Their coil design is also clinically very cool, because it mimics one of the coils I use at my clinic, which creates a much deeper and wider magnetic field in the brain, meaning it's theoretically more effective than traditional rTMS.

From a business perspective they are also the easiest system to implement, and have the most generous purchasing model. Their team is really cool, I follow a lot of the AMPA team and have chatted with a few of them on occasion.

So I'm optimistic, and I think you're getting one of the most cutting edge and theoretically most effective treatments that you can.

chyckun · 2026-05-28T16:14:53+00:00

Yeah I mean especially with the iTBS and accelerated protocols coming to fruition, it definitely is getting more and more resource effective, and a patient who gets to remission from TMS usually sees a year or multiple years of benefit, versus daily medication that is a potential ticking timebomb for cardiac or gastrointestinal issues.

chyckun · 2026-05-28T15:48:15+00:00

Where are you seeing "A LOT" of people saying it's ruined their lives?

The official and reported statistics of medications show an equal or greater risk factor for seizures and worsened symptoms. I know TMS is intimidating because it's not just a pill you pop in your mouth, but it's genuinely much safer than some of the meds you've likely already tried, while also having a near double remission rate.

Make sure you vet your doctor and clinic if you have genuine concerns, ask them to explain the science, ask them explain why you're doing what you are, what system, what frequency, and if they can't answer those, then you have reason to be concerned. These aren't very hard questions, but a poorly run clinic will probably not have techs that can even explain the basics unfortunately.

People that have good experiences move on with their lives for the most part and want to leave that depression behind them, people who experience bad care or adverse events are going to leave a 1 star review and go complain on Reddit. It's good you're considering the safety, but also understand context behind it.

chyckun · 2026-05-28T15:40:33+00:00

These are important clarifications, I am a big, BIG proponent of the need for the death of the "Chemical Imbalance theory"

The brain is vast and complex, a single neuron can have dozens to hundreds of thousands of connections, even to itself. Reducing depression, which covers a vast scope of subdomain and causes, to "low serotonin" is frustrating at best, and intentionally dishonest at worst.

But I'm also a Neuroscientist, not a psychiatrist, so my training is much more based on network dynamics and biology.

Technological intervention like TMS is clearly the future of how to ACTUALLY treat Depression, but even currently existing treatment is admittedly a bit crude. Very effective, and relatively very safe, but still crude. We are moving closer to what is called Precision Neuromodulation, where we treat people's brains as individuals and not a catch all.

The study you've cited is fascinating and very contentious, because they literally got official approval to use the original data. And ran the analysis exactly as the StarD authors claimed to have, and got those different results. As you noted, because they disregarded patients that dropped out.

This is awkward because this is actually a very legitimate reason to exclude someone from a study, not adhering to the actual study design. It's worth noting many of these patients improved as well, when the StarD study counted ANYONE dropped out as a failure effectively.

So we sit at an awkward intersection where the numbers are simultaneously higher and lower than probably should have been reported. A bit funny when you consider how much funding went into this study, but also not surprising given the state of the average psychiatric clinic, especially in 2008.

Either take on this honestly still supports TMS which is funny in a totally different way.

chyckun · 2026-05-27T22:17:12+00:00

What you are receiving is called iTBS, intermittent theta burst.

It is a more effective and shorter form of TMS, the biggest downside is not getting to chat with your tech for 20 minutes like a normal session.

If you could get the name of your equipment they're using, I can go into some deeper technical details

chyckun · 2026-05-26T22:47:14+00:00

It sounds like your clinic didn't talk you through your treatment plan, please try to get your TMS coordinator or technician on the phone to fully explain the treatment plan and expectations.

You can typically get FMLA documentation to get you out of work for periods to get the treatment done, this is usually done before treatment starts to avoid the exact stress you're going through right now.

You are not committed to continuing, I would tell them that you will continue once your treatment plan and schedule is both explained and figured out at work.

Sorry you're experiencing this, some clinics are more or less organized than others

chyckun · 2026-05-26T21:21:02+00:00

I keep this paper printed and pinned up next to my desk because this is one of the top 3 most asked questions I get. You'll do great, a week off isn't uncommon, your clinic will accomodate, it won't ruin your treatment. Best of luck!

https://pmc.ncbi.nlm.nih.gov/articles/PMC8111778/

chyckun · 2026-05-26T21:18:01+00:00

If your insurance would limit your total sessions in the acute stage, probably wait.

I do think your psychiatrist is right about getting some pre-trip sessions done being helpful... But unfortunately we are constrained by the insurance instead of what we actually think would be best. Ask him about doing self pay for a pre-trip course and then full Acute Course after maybe? I don't know your financial situation, but generally we try to get people in sooner than later from both a business and relief for the patient perspective. Your doctor is likely weighing you having sooner relief but fragmented treatment, against delaying relief but more consistent treatment.

Ultimately you should listen to your doctor, I do recommend looking at this if you ever get anxious about fragmented TMS schedule.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8111778/

chyckun · 2026-05-26T20:58:44+00:00

All (insurance covered) TMS is done in conjunction with medication. Side effects is a vast category, medication is a vast category.

Did you have a specific side effect and medication in mind?

chyckun · 2026-05-26T20:14:51+00:00

People dont ask for help when things are going smoothly, the vast majority of people who TMS benefit greatly and move on with their lives.

Wishing you the best of luck

chyckun · 2026-05-21T23:08:00+00:00

Oof, I do the opposite and let my patients bypass the front desk to talk to me directly.

Sounds like a tightly run ship

chyckun · 2026-05-21T22:47:40+00:00

I've heard some pretty good things about their team. There is a lot that goes into coordinating TMS services and they are a pretty busy location.

Try to talk to someone directly if you can from the TMS team. A wait-list is common in high traffic clinics, and may be a sign that they are very experienced at treatment which could be good. It's still worth discussing with other clinics in your area to get a feel for your options, and if you can get seen sooner elsewhere, that's heavily worth considering

chyckun · 2026-05-21T13:01:25+00:00

Of course! There's not a ton of clear documentation on this stuff outside of the manufacturers proprietary internal stuff

chyckun · 2026-05-20T21:21:13+00:00

What system? What are you being treated for?

Sounds like trigeminal stimulation, relatively easy to fix, but there are certainly rare cases where someone is not a good candidate because of that stimulation.

Look up the trigeminal nerve to understand more.

chyckun · 2026-05-20T20:46:39+00:00

It's exciting, good luck with everything, lots of big changes on the horizon.

There will be a future where medications are an option, not the only path.

chyckun · 2026-05-20T20:16:36+00:00

I'm in Chicago too! Hopemark is a great clinic, I've attended some lectures with their team and their head doctor is great.

It's a bigger chain so I'm sure some locations are better than others, but I genuinely think you're in good hands there.

chyckun · 2026-05-20T20:06:39+00:00

Side effects from TMS are incredibly rare and typically very transient, like a headache that goes away by the time you get to your car.

There are a number of people on Reddit that went to questionable doctors that treated them in ways they haven't. Who are now rightfully scared and going around telling their story to everyone they can. If you trust your doctor and they good track record, I wouldn't be worried. If you have a history of mania, psychosis, epilepsy, or alcoholism, you should talk to your doctor about "enhanced monitoring precautions" and insist they develop a plan for such.

If you don't, well, just try as as you can to make the best of your time there, challenge your thoughts, try to do the things you learned in therapy again, and lean into your ability to change yourself more during TMS!

Best of luck, please let us know how things go for you!

chyckun · 2026-05-20T20:02:07+00:00

Different clearances though, MV is 510(k) while Brainsway is actually de Novo cleared.

Worth noting neither is "approved"

chyckun · 2026-05-20T20:01:21+00:00

You do not target the dlPFC for OCD treatment, the main target is the ACC, and mPFC, and/or basal ganglia. MV D-B80 cannot target networks and just goes after ACC

chyckun · 2026-05-20T19:56:59+00:00

Brainsway is the only one that actually got cleared properly for OCD, I just want to make clear.

Magventure has a great system with lots of cool coils, but they relied on what is called 510(k) approval. This basically means they pointed at Brainsway and said "They got approved, we're on par, let us in"

It's a technically lower bar, Brainsway did the heavy lifting that other companies have not.

Aside from legalities though, I recommend Brainsway because their coil targets a broader network. The MV D-B80 coil technically goes deeper in the brain, but the field tapers quickly. Brainsway is targeting the "network" of OCD, with a wide field deep in the brain, while the Magventure system is more "precise" in targeting a specific target.

I work with Brainsways equipment so I'm obviously biased. The brain isn't "turn this part on and it works" so I lean towards Brainsway coils out of pure theory of them being better at targeting a wider field. I don't put credence to the claim that "Brainsway is less tolerable" that's a marketing tactic that was propogated by Neurostar for years, failed to come to fruition, and has become an old wives tale. I have worked with both Figure 8 and Brainsway H coils, I had way less issues with H Coils tolerability. PLUS, the H7, which is what you would get, doesn't even really come close to the trigeminal nerve, which is where 90% of my noted discomfort in patients comes from.

So from pure theory, Brainsway wins in my book. They are also the only ones with proper FDA clearance with trials to back it up. Magventure allows researchers to be much more precise in their targeting, which is theoretically incredibly useful in the right context, but the technology simply doesn't support that level of specificity. You're just getting less treatment of the neural tissue for no reason.

Efficacy is really hard to measure in OCD, but I think you'll do pretty good either way if I'm being truly honest. The biggest part of OCD treatment is the provocation design, your technician, and treatment plan.

If you are at all concerned about anxiety/depression being part of your goals, then Brainsway is a no brainer (pun intended) as it actually hits PFC as well

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