Transcranial Magnetic Stimulation (TMS) is an effective interventional treatment for patients with treatment-resistant depression, offering hope where medications have fallen short.

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By adding TMS as a service line, you can provide a non-invasive, FDA-cleared treatment that improves outcomes for your most difficult-to-treat patients while building a sustainable and profitable practice.

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But adding TMS isn't about buying a device and waiting for patients to show up. Practices that thrive with TMS get three things right: quality of care, technology selection, and patient awareness. Miss any one of these pillars, and you'll struggle. Nail all three, and TMS becomes both clinically rewarding and financially sustainable.

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Pro tip: Osmind helps TMS practices excel across all three pillars, from outcome tracking that demonstrates quality, to billing automation, to patient engagement tools that keep your pipeline full.

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In this guide, we'll cover:

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Pillar 1: Quality

• What is TMS and how does it work?
• Which patients are eligible for TMS treatment?
• What does a successful treatment protocol look like?

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Pillar 2: Technology

• How do you choose the right TMS device for your practice?
• What does treatment room setup look like?

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Pillar 3: Awareness

• How do you navigate billing and reimbursement?
• How do you market TMS to build your patient pipeline?

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Pillar 1: Clinical Quality

Your reputation is built on outcomes. TMS works. Standard protocols show response rates of 50–60% and remission rates around 30%, and newer accelerated protocols are pushing those numbers even higher. But results depend on clinical rigor.

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What is TMS and how does it work?

TMS (Transcranial Magnetic Stimulation) is an FDA-cleared, non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation. Unlike medications that affect the entire body, TMS targets the dorsolateral prefrontal cortex directly, the region most implicated in depression.

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The treatment requires no anesthesia, no sedation, and patients can drive themselves home immediately after sessions. Most patients describe the sensation as a light tapping on the scalp.

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TMS was first FDA-cleared for treatment-resistant depression in 2008 and has since gained clearances for OCD, anxious depression, and smoking cessation. With over 15 years of clinical use, TMS has established itself as a safe, effective option when antidepressants aren't enough.

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Which patients are eligible for TMS?

Not every patient is a TMS candidate. Proper patient selection is foundational to both clinical outcomes and insurance approval.

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FDA-cleared indications:

• Treatment-resistant depression (MDD): Patients who have tried and failed at least one antidepressant (some insurers require two or more failed trials)
• OCD: FDA-cleared for both Brainsway's Deep TMS H-coil and MagVenture's deep coil, targeting deeper brain structures involved in obsessive-compulsive circuits
• Anxious depression: Currently FDA-cleared for Brainsway's Deep TMS
• Smoking cessation: FDA-cleared for Brainsway's Deep TMS

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Common off-label uses:

TMS is also used off-label for a growing list of conditions, including anxiety disorders, chronic pain, PTSD, TBI, stroke rehabilitation, addiction, postpartum depression, and bipolar depression. The evidence base varies by condition, but clinicians are increasingly incorporating TMS into treatment plans for these populations.

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In Europe, TMS carries CE marking for substantially more indications than the FDA has cleared in the U.S., including bipolar disorder, PTSD, schizophrenia (negative symptoms), Alzheimer's disease, autism spectrum disorder, chronic neuropathic pain, multiple sclerosis, Parkinson's disease, and post-stroke rehabilitation. CE marking reflects a different regulatory threshold than FDA clearance, but it signals growing international recognition of TMS across psychiatric and neurological conditions.

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Standard eligibility criteria for depression (the most common use case):

• Major Depressive Disorder diagnosis confirmed through clinical evaluation
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• Failure of at least one adequate antidepressant trial (payor requirements vary)
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• No contraindications: patients should not have ferromagnetic metal implants in or near the head (excluding standard dental work), active seizure disorders, or history of epilepsy

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TMS can be used as monotherapy or as an adjunct to existing medication regimens. Many patients continue their antidepressants during TMS treatment.

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Patients who may not be candidates:

• Those with implanted medical devices (pacemakers, cochlear implants, deep brain stimulators)
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• Patients with a history of seizures or epilepsy
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• Those with ferromagnetic objects in or near the head

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Setting realistic expectations for TMS

TMS helps many patients, but it's not a guarantee. Honest conversations upfront about what "improvement" looks like lead to better patient satisfaction, even when outcomes are partial.

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Standard TMS protocols show response rates of 50–60%, and accelerated protocols (such as Stanford's SAINT protocol or accelerated deep TMS) have demonstrated response rates as high as 80–90% in clinical trials, though these involved smaller sample sizes. The field is moving quickly, and the response rates your patients experience will depend on the protocol, the device, and how consistently they show up.

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One thing worth keeping in mind: standard outcome scales don't always capture the full picture. A patient who had panic attacks dozens of times a day before TMS and now has them once or twice a week has made a meaningful change in their quality of life, even if their PHQ-9 score only budged a few points. Partial response still matters. Talking to patients about what day-to-day improvement looks like, not just what a scale says, helps set the right frame.

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What does a successful TMS treatment protocol look like?

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TMS outcomes depend on consistent delivery:

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• 36 sessions is the standard acute course (some patients benefit from additional sessions)
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• Session frequency: The standard protocol is 5 days per week, but research supports that patients who come in 3 or more times per week achieve comparable outcomes. A 2012 RCT (Galletly et al., Psychological Medicine) found no significant difference in final depression outcomes between 3x/week and 5x/week groups when total session counts were equivalent.
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• A larger retrospective study (Kokdere et al., 2020; n=303) confirmed that treatment gaps of up to 14 days during the acute phase did not predict worse results. For patients who can't commit to 5x/week, 3x/week over a longer course (6+ weeks instead of 4) is a reasonable alternative. It just takes a bit longer.
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• Proper motor threshold determination ensures accurate dosing

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Measurement-based care for TMS

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Track outcomes systematically using validated scales:

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• PHQ-9 at baseline and regular intervals (every 6–10 sessions)
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• A clinician-administered scale such as the MADRS or HAM-D. Most payors want to see at least one clinician-rated measure in addition to patient self-report
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• Document response and remission rates for your practice
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• Use data for insurance negotiations and to demonstrate value to referrers
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Practices that track outcomes rigorously build stronger reputations and negotiate better reimbursement rates.

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Pillar 2: How do you choose the right TMS device?

The TMS device market has matured significantly. You have real choices, and the "best" device depends on your specific situation. Device selection is one of the most consequential decisions you'll make when launching a TMS practice. Each device has distinct advantages depending on your practice goals, patient volume, and budget.

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Key considerations:

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1. Figure-8 Coil vs. Deep Coils

Figure-8 coils (NeuroStar, MagVenture, MagStim, Apollo, CloudTMS) target superficial cortical areas with precision. Deep coils penetrate deeper brain structures and have FDA clearances beyond depression. Brainsway is the best-known deep TMS manufacturer, but MagVenture (Cool D-B80 coil) and CloudTMS (DCC deep coil) also have FDA-cleared deep coils for OCD.

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Worth noting: a 2022 study in Translational Psychiatry found meaningful differences in electric field distribution between Brainsway's H-coil and other deep coils, with the H-coil stimulating significantly larger brain volumes. Clinical equivalence hasn't been independently established in large trials for the non-Brainsway deep coils.

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2. Treatment duration

• Standard protocols: 19–37 minutes per session
• Theta burst (iTBS) protocols: 3–9 minutes per session (available on most modern devices)

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3. Financing your TMS device

Most TMS manufacturers don't offer direct financing. Instead, they'll connect you with third-party specialty lenders. You'll typically be presented with options to finance or lease-to-own, and the total costs tend to be similar between the two.

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The key difference is tax treatment: financing (purchasing via a loan) lets you take advantage of Section 179 tax deductions, which allows you to deduct the full cost of the device in the year of purchase. Leasing does not qualify for Section 179. For a more detailed breakdown of financing options, including bank/SBA loans and ROI projections, Solstice Training Institute has a helpful guide on TMS machine financing.

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TMS Device comparisons

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NeuroStar (Neuronetics)

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• Market position: The first FDA-cleared TMS device (2008) with the largest U.S. install base. Over 1,100 practices currently offer NeuroStar, with 8.2 million+ treatments delivered across 229,000+ patients.
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• Strengths: Strong brand recognition and the deepest insurance relationships of any TMS manufacturer, with coverage from 95+ major U.S. private insurers. NeuroStar employs 10 dedicated reimbursement specialists.
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• Treatment time: 19 minutes (standard) or 3 minutes (theta burst)
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• Pricing: ~$89,000–$115,000 purchase; lease options available. Note that NeuroStar uses a pay-per-use model ($65/treatment after the first 500), which effectively makes Neuronetics a revenue-sharing partner.
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• Consider if: You want the most established device with the broadest insurance footprint

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Brainsway (Deep TMS)

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• Market position: The leading deep TMS device with H-coil technology and the broadest FDA clearances of any TMS manufacturer
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• Strengths: FDA-cleared for depression, OCD, anxious depression, and smoking cessation. Multiple real-world studies suggest Brainsway's deep TMS produces higher response and remission rates compared to standard figure-8 TMS devices, though head-to-head trial results have been mixed. A large post-marketing analysis (Tendler et al., Psychiatry Research, 2023) and additional real-world datasets point to a trend of better outcomes with deep TMS, which tracks with the current understanding that stimulating more brain volume tends to produce stronger results. At minimum, Brainsway has demonstrated higher rates of real-world outcomes compared to other TMS machines. The helmet-based coil design makes positioning notably easier than other devices, reducing technician training time and variability. Neural network-based coil design allows deeper and broader brain stimulation.
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• Treatment time: 20 minutes (standard) or 3 minutes (theta burst for depression)
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• Pricing: Brainsway is among the more expensive options in the TMS market, and pricing depends on the coil configurations purchased. As of 2026, the purchase price range is roughly $120,000–$180,000. Brainsway also offers lease and risk-share/per-use models. Contact Brainsway directly for a current quote based on your specific needs.
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• Consider if: You want to treat OCD, plan to market multiple indications, or prioritize ease of use and high efficacy rates

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MagVenture

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• Market position: Flexible, research-grade equipment popular in academic settings. Danish manufacturer with 30+ years in TMS.
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• Strengths: Highly customizable protocols with 35+ coil options, including the Cool D-B80 deep coil (FDA-cleared for both MDD and OCD with a single coil as of 2025). First manufacturer to receive FDA iTBS
  clearance (2018). Competitive pricing with no per-session fees.
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• Treatment time: Variable based on protocol
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• Pricing: ~$69,000–$89,000
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• Consider if: You want protocol flexibility, deep coil capability without Brainsway's price tag, or have research interests
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MagStim

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• Market position: UK-based manufacturer (Whitland, Wales) that built the first commercial TMS machine in 1985. MagStim is often confused with MagVenture, but they're completely separate companies.
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• Strengths: Long track record, air-cooled coils (faster between patients but louder), StimGuide neuronavigation at higher tiers. FDA-cleared for MDD and OCD (Horizon Inspire, 2024).
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• Treatment time: Standard and theta burst available
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• Pricing: ~$65,000 (Horizon Lite) to ~$125,000 (Horizon Performance + StimGuide), plus $7,000–$9,500/year warranty
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• Consider if: You want a proven manufacturer with neuronavigation options at a mid-range price
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Apollo TMS (Neurolief)

• Market position: Compact, budget-friendly option with built-in navigation system
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• Strengths: Smaller footprint, built-in navigation, lower price point
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• Treatment time: Standard and theta burst available
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• Pricing: ~$50,000–$59,000
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• Consider if: Budget is a primary concern or you have limited space
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CloudTMS (Neurosoft)

• Market position: Budget-friendly figure-8 device manufactured by Neurosoft (Russia), marketed in the U.S. by TeleEMG. Think of it as a more affordable alternative to MagVenture.
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• Strengths: Transparent pricing (unusual in the TMS industry), no per-session fees, liquid-cooled coil, FDA-cleared for MDD and OCD (deep coil). Modular design. Claims 1,500+ units installed across 35+ countries.
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• Treatment time: 3 minutes (iTBS), 19 minutes (standard), and 36.5-minute protocols available
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• Pricing: ~$53,000 purchase (machine + chair) plus $2,500/year warranty. Lease-to-own available at approximately $900–$1,300/month over 5 years.
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• Consider if: Budget is a priority and you want a straightforward, no-per-session-fee device
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Nexstim

• Market position: Premium neuronavigated TMS from Finland. This is a fundamentally different product category from the devices above. Nexstim is the only commercially available TMS system with true E-field (electric field) neuronavigation using the patient's own MRI.
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• Strengths: The system creates a 3D brain rendering from the patient's structural MRI and calculates real-time electric field distribution as the coil moves, using infrared stereotactic tracking. This replaces the crude "5 cm rule" with individualized, anatomy-based targeting. Motor cortex mapping validated to within ~2.1 mm compared to direct electrical stimulation. FDA-cleared for MDD and pre-surgical brain mapping.
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• Treatment time: Standard and theta burst available
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• Pricing: ~$100,000 purchase plus $12,000/year warranty. Lease at ~$8,000/month (reducible to $5,000/month if the clinic shares anonymized patient data with Nexstim's registry). Each patient also needs a structural MRI, which adds cost.
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• Consider if: Precision targeting is a priority, you have research interests, or you serve complex cases where standard targeting may be insufficient
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Ampa (New Entrant)

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• Market position: The newest and most disruptive entrant in the TMS market. Ampa received FDA clearance in February 2025 and announced a nationwide rollout in October 2025. Founded by Don Vaughn, Ph.D., backed by $18 million in funding.
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• Strengths: Portable (two wheeled Pelican suitcases), handheld coil weighing just 2.2 lbs (vs. 10+ lbs for conventional coils), ships with two coil types: an L coil (equivalent to standard figure-8) and an M coil (equivalent to deep TMS H-coils). Camera-guided neuronavigation ("Fovea" system) and pre-printed caps eliminate manual head measurements, reducing setup to under one minute. Training takes hours, not weeks. Claims ~15 full treatment courses per workweek vs. 2–3 for conventional devices.
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• Treatment time: Standard and theta burst protocols available
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• Pricing: $3,000/month all-inclusive subscription (device, both coils, training, cloud software, repairs/replacements, installation). The only additional cost is $30 per disposable cap. Month-to-month, no capital expenditure.
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• Consider if: You want to add TMS without a major upfront investment, need portability (multiple locations, home visits), or want dual coil capability at a fraction of the traditional cost

For a deeper look at Ampa, see our blog post: Next-Generation Portable TMS: Expand Your Practice with Ampa
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What does a TMS treatment room setup look like?

Creating a comfortable, efficient treatment space matters for patient experience and operational flow.

Room requirements:

• Space: Minimum 10x10 feet; the TMS chair and device need adequate clearance
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• Electrical: Dedicated circuit recommended; check device specifications
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• Sound considerations: TMS produces a repetitive clicking sound during treatment. Soundproofing should be comparable to any therapy room, since technicians should be talking with patients during sessions (more on that below). Standard solid walls work fine. Glass walls between treatment rooms and common areas aren't ideal.
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Patient comfort essentials:

• Comfortable treatment chair: Many devices come with integrated chairs; some practices purchase recliners separately
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• The technician-patient conversation: There's an active debate in the TMS community about whether patients should be watching TV or scrolling during sessions. Many experienced TMS clinicians, including TMS expert Ben Spielberg, believe technicians should be actively conversing with patients during treatment, not handing them a tablet. The therapeutic relationship between the technician and patient can meaningfully affect engagement, adherence, and outcomes. If you do offer entertainment options, consider making conversation the default and screens the exception rather than the other way around.
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• Blankets and pillows: Small touches that improve the experience
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• Earplugs or noise-canceling headphones: Standard practice for patient comfort during treatment
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• Calm environment: Soft lighting, neutral colors, minimal clinical appearance

Staffing considerations:

TMS can be administered by trained technicians under physician supervision. One technician can often manage 2–3 patients per hour once experienced, making TMS operationally efficient compared to treatments requiring direct physician presence throughout.

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Pillar 3: How do you make TMS profitable for your practice?

A TMS device generates zero revenue sitting idle. The most common reason TMS practices struggle is underutilization within their patient base. Building awareness among potential patients and referral sources while mastering reimbursement is essential.

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How do you market TMS to build your patient pipeline?

Don't wait until the device arrives to start marketing. Building your pipeline takes time.

Patient-facing marketing:

• Website: Dedicated TMS page explaining the treatment, candidacy, and what to expect
• Google Ads: Target searches like "TMS near me," "treatment-resistant depression treatment," "TMS therapy [your city]"
• Patient testimonials: Video testimonials (with consent) are particularly powerful for TMS
• Social media: Educational content about TMS, patient success stories, myth-busting posts

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Read: How to Get More Psychiatry Patients (10 Proven Strategies)

Read: Building Your Private Psychiatry Practice
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Referral network building:

• Primary care physicians: Many PCPs don't know TMS is available locally. Lunch-and-learns can be highly effective.
• Other psychiatrists: Colleagues without TMS capabilities may refer their treatment-resistant patients
• Therapists and psychologists: Often see patients struggling despite medication; keep them informed about TMS as an option
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Read: How to Build a Psychiatry Referral Network That Works
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Key marketing messages:

• Non-invasive, no medication side effects
• FDA-cleared with 15+ years of clinical evidence
• Most patients see improvement within 4–6 weeks
• Covered by most insurance plans

Avoid overpromising. Set expectations that TMS helps many patients significantly, not that it "cures" depression.

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Read: Psychiatry Private Practice Growth Tips Part 1

Read: How to Hire and Build an Interventional Psychiatry Team

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How do you navigate TMS billing and reimbursement?

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TMS reimbursement has improved significantly since FDA clearance, though navigating insurance requirements remains a core part of running a successful TMS practice.

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Common CPT codes for TMS:

• 90867: Initial TMS treatment (includes motor threshold determination)
• 90868: Subsequent TMS treatment
• 90869: TMS re-determination of motor threshold

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Insurance landscape for TMS:

• Commercial insurance: Most major payers now cover TMS for treatment-resistant depression, typically requiring documentation of 2+ failed antidepressant trials
• Medicare: Covers TMS; rates and medical necessity criteria vary by geographic location
• Prior authorization: Almost always required; expect to document treatment history thoroughly

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Tips for successful TMS reimbursement:

• Document failed medication trials thoroughly in patient records before initiating TMS
• Use validated depression scales (PHQ-9 plus a clinician-administered measure like the MADRS or HAM-D) to demonstrate treatment resistance and track outcomes
• Submit prior authorizations early, as approval can take 1–2 weeks
• Track outcomes meticulously. Insurers increasingly want to see measurement-based care data

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Financial considerations/ROI  for TMS:

• Average reimbursement: $200–$350 per session (varies by payer, geography, and provider type)
• Typical treatment course: 36 sessions over 6–9 weeks
• Most practices need 2–4 active TMS patients at any time to cover costs and generate meaningful margin
• Consider offering self-pay options for patients without coverage or seeking faster access

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Bringing it all together

TMS represents a real opportunity to expand your treatment offerings and help patients who have exhausted other options.

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Successful TMS practices aren't built on any single factor. They deliver excellent care (Quality), choose equipment that fits their needs and budget (Technology), and actively build their patient base (Awareness).

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Weakness in any pillar undermines the others:

• Great marketing with poor outcomes destroys your reputation
• Excellent clinical skills with an empty schedule wastes your investment
• The best device in the wrong practice environment creates friction

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With proper planning across all three pillars, you can build a thriving TMS practice that benefits both your patients and your bottom line. The investment is substantial, but the clinical and financial returns are real.

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Osmind supports TMS practices across all three pillars: outcome tracking for quality demonstration, streamlined documentation and billing, and patient engagement tools to maintain your pipeline. Learn how Osmind can help you launch and grow your TMS service line.