Everything you need to know about Kaiser Permanente and TMS: Referrals, Coverage and Outside Care — how it works, what it costs, and how to find a provider who actually knows what they're doing.
The TMS Patient Buyer's Guide
Everything to know before your first consult — questions to ask, what to expect, and how to compare providers.
Kaiser Permanente can cover TMS for treatment-resistant depression, and the route in starts with your Kaiser mental health team, not with a private clinic. In most cases your Kaiser psychiatrist decides whether TMS makes sense and submits the referral, and Kaiser reviews the request against its own criteria. Where the treatment is delivered, and who delivers it, depends on your region.
That’s the main difference from a typical insurer. Kaiser is an integrated system: the same organization is your health plan and your care provider. That changes how referrals, approvals and outside care work.
Key takeaways
- Kaiser is an integrated system. The plan and the doctors work together, so TMS usually starts with a referral from a Kaiser clinician.
- Kaiser’s regions are separate health plans with their own published criteria. What applies in one region may not apply in another.
- One published regional document (Washington) shows that TMS for treatment-resistant depression is reviewed against a proprietary criteria set, and that other diagnoses go to a medical director.
- Kaiser says it can share the criteria used for an individual member’s decision. You can ask.
- If your region doesn’t offer TMS in-house, ask Kaiser in writing whether it will authorize outside care, and don’t start until you have the answer.
How Kaiser is different from other insurers
At most insurers, your psychiatrist or a TMS clinic sends a prior authorization request to a separate company. At Kaiser, the health plan and the medical group work together under one umbrella. So there is no outside clinic filing a form to an outside payer. Instead, your Kaiser clinician refers you internally, and Kaiser reviews the request through its own utilization management process.
Two practical consequences:
- The first step is your Kaiser psychiatrist or mental health clinician. Not a private TMS clinic.
- Network rules are tighter than many PPO plans. Kaiser plans generally cover care from Kaiser providers and Kaiser-contracted providers. Care outside that network without Kaiser’s authorization may not be covered. Your Evidence of Coverage is the document that spells this out for your plan.
What Kaiser’s published criteria show
We can only describe what Kaiser has published. One example is the Kaiser Foundation Health Plan of Washington clinical review criteria for TMS. It is specific to Washington and states that it applies only to Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. It covers these points:
- Non-Medicare members, treatment-resistant depression. Kaiser uses MCG guideline B-KP-801-T, in a version effective August 1, 2024. MCG guidelines are proprietary, so the criteria text isn’t printed in the document.
- Other diagnoses. These require Medical Director review.
- Medicare members. The document points to the local coverage determination L37088 and the related billing and coding article, A57693.
- Sharing criteria. The document says Kaiser can share a copy of the specific criteria used to make a utilization management decision on an individual member basis.
- Disclaimer. Member contracts differ, and the document tells members to check their Evidence of Coverage or call member services.
The file’s own subject line also states that preauthorization is required for rTMS. The document doesn’t spell out the MCG criteria, so we can’t tell you how many medications Kaiser asks you to have tried. Don’t trust a forum post that states a number for “Kaiser” in general. Ask Kaiser for the criteria that apply to you.
What the referral can look like
Kaiser’s own communications give one example from the Mid-Atlantic region. A May 2018 Kaiser article described how that region’s program, which started in September 2017 at a Northwest D.C. medical center, worked: a patient who met criteria for a major depressive episode was seen by a psychiatrist, who then referred them to the TMS physician through an internal referral. Treatment ran on weekdays over four to six weeks, with sessions of about 40 minutes.
That article is old, and other regions run their programs differently. We include it only to show the shape of an internal referral. For the current setup in your area, ask your Kaiser team.
Availability depends on where you live
We couldn’t find a current, official list of Kaiser medical centers that deliver TMS, and what we found suggests availability varies by region and by medical center. Here are the questions to ask:
- Does my Kaiser region offer TMS at one of its own medical centers?
- If not, does Kaiser contract with an outside TMS provider, and will it authorize me to go there?
- Which devices and protocols does the program use? Standard TMS, deep TMS and theta burst differ in session length and schedule. Our deep TMS vs. standard TMS comparison and theta burst guide explain the differences.
- How long is the wait for an evaluation?
- How do I travel to sessions? Most courses are five days a week, so distance matters. Our week-by-week timeline shows what the schedule looks like.
Going outside Kaiser for TMS
Some people have a hard time getting TMS through Kaiser, either because there’s no program nearby or because the wait is long. Before you go outside, understand the choices.
| Path | How it works | What to confirm |
|---|---|---|
| Kaiser delivers TMS | Referral from your Kaiser clinician, internal review | Wait time, location, protocol |
| Kaiser authorizes an outside provider | Kaiser approves care at a named provider | Written authorization, provider name, number of sessions, dates |
| You go outside without authorization | You arrange care yourself | Your Evidence of Coverage. Kaiser may not pay, so you may owe the full cost |
| Self-pay | You pay the clinic directly | Total cost, payment plans, refund policy |
If you choose a private clinic and Kaiser hasn’t authorized it, expect to pay out of pocket. Our guide to the real cost of TMS therapy covers what that can look like, and our clinic questions list helps you compare.
One caution: some private clinics say they accept Kaiser. Treat that as a question, not an answer. Ask the clinic whether they are contracted with Kaiser or only able to give you paperwork for reimbursement, and then ask Kaiser what it will pay.
If you have Kaiser through Medicare
Kaiser offers Medicare Advantage plans. Under Medicare rules, your plan generally has to follow Medicare’s coverage policies, which for TMS come from regional local coverage determinations (LCDs). The Washington document lists L37088 as the applicable LCD for Medicare members there. Other regions fall under their own Medicare contractor’s LCD. Our Medicare TMS coverage update explains what those policies say.
If Kaiser says no
- Ask for the denial in writing, including the criteria used.
- Ask for the criteria document. Kaiser’s published criteria say it can share the document used for an individual decision.
- Ask your psychiatrist for a letter explaining why TMS is medically necessary for you.
- File an appeal. Kaiser members have a grievance and appeals process outlined in their Evidence of Coverage and member materials. Your denial letter should list the steps and deadlines.
- Ask about independent review. For many plans, an external review is available after the internal process. Check your denial letter and state rules.
Our TMS insurance appeals guide lays out how to build a strong appeal.
What to do next
Start with your Kaiser psychiatrist. Ask: “Is TMS an option for me, and does my region offer it?” Bring your medication history; our post on talking to your psychiatrist about TMS can help you prepare. If you want to check where you stand first, take our TMS candidate quiz. If you decide to look at options outside Kaiser, you can browse TMS clinics near you and see our Kaiser Permanente insurance page.
Kaiser’s criteria and programs change, and they differ by region. Confirm every detail with Kaiser member services before you start treatment.
FAQ
Does Kaiser Permanente cover TMS?
Kaiser covers TMS for treatment-resistant depression when its criteria are met, according to published criteria like the Washington document above. Your region and plan determine the specifics, so confirm with Kaiser.
Do I need a referral for TMS at Kaiser?
Generally yes. The route starts with your Kaiser clinician, who refers you and submits the request. Ask your psychiatrist how it works in your region.
Can I see a private TMS clinic with Kaiser insurance?
Only if Kaiser authorizes it or the clinic is part of Kaiser’s network. If neither applies, Kaiser may not pay. Get written authorization before you book.
What medications do I need to have tried for Kaiser to approve TMS?
Kaiser’s criteria for non-Medicare members are a proprietary MCG guideline, so we can’t list them. Kaiser says it can share the specific criteria used for an individual decision. Ask your psychiatrist or Kaiser.
Does Kaiser cover TMS for conditions other than depression?
The Washington criteria say that diagnoses other than treatment-resistant depression require Medical Director review. That suggests they are decided case by case.
Is Kaiser’s TMS the same as TMS at a private clinic?
The treatment is the same type of therapy, but the devices, protocols, schedules and staffing may differ. Ask what device and protocol will be used.
