Insurance Approval Probability

Determine the likelihood of getting prior authorization for TMS or Spravato based on typical commercial insurance "step therapy" requirements.

1. Primary Diagnosis

2. Medication History

How many distinct antidepressant medications from different classes (e.g., SSRI, SNRI) have you tried at adequate doses for at least 4-6 weeks without sufficient remission?

3. Psychotherapy History

I have completed an evidence-based course of psychotherapy (e.g., CBT) without full symptom resolution.

TMS Coverage Probability

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Standard rule of thumb: If you have a primary diagnosis of severe MDD, have failed 4 or more antidepressant trials, and have tried psychotherapy, your probability of TMS coverage is very high (>90%). If you have failed fewer than 2 meds, or are seeking treatment for generalized anxiety, probability is extremely low.