Everything you need to know about Can You Do TMS Again? Retreatment, Second Courses and Insurance — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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Yes, you can do TMS again. If depression comes back after a course that helped, a second course is a recognized option, and the research we found suggests most people who responded the first time respond again. Insurance is the harder part. Many plans have separate rules for a repeat course, and they usually want proof that the first one worked.
If you are reading this because depression is creeping back, that is hard news to sit with. A relapse does not mean TMS “wore off” because you did something wrong, and it does not close the door on feeling better.
Key takeaways
- A second acute course of TMS is a standard, recognized option for people who responded the first time and then relapsed.
- In a 2026 study of 177 people who responded to TMS before, 82.5% responded again to a second course. That study had no control group, so treat it as encouraging rather than proof.
- Most insurers ask for documentation: a strong response to the first course (often at least a 50% drop in symptoms), then a clear return of symptoms.
- Some plans set a minimum wait between courses. One Medi-Cal form we reviewed expects the prior course to have ended at least six months earlier.
- Maintenance sessions (booster treatment to prevent relapse) are treated differently, and many insurers do not cover them.
What the research shows about a second course
The best recent data on repeat courses is a study published in Acta Psychiatrica Scandinavica in 2026. Researchers reviewed records from 20 outpatient centers and identified 259 patients who got at least two TMS courses. The main group was 177 people who had responded to an earlier course. Among them, 146 (82.5%) responded again to course two, and 96 (54.2%) reached remission, using standard 10 Hz treatment of the left prefrontal cortex. Among responders, the first session that met the response threshold came earlier in retreatment than in the first course: a median of session 12 versus session 16 on the PHQ-9 (PubMed abstract).
A few honest caveats:
- It was retrospective and had no comparison group, so it cannot tell us how these patients would have done on other treatments.
- The authors themselves write that “evidence to guide use of a second acute course is strikingly limited.”
- Some authors disclose financial ties to TMS companies, which is normal in this field but worth knowing.
- The people studied had responded the first time. The data do not tell us what to expect if your first course did not help.
An older study fills in the picture of relapse. In a 2014 Journal of Clinical Psychiatry study that followed 257 people for a year after a TMS course, 62.5% of those who responded or remitted at the end of treatment still met response criteria through 12 months, and 36.2% of the whole group received reintroduction of TMS during follow-up (Dunner et al.). In other words, relapse happens, and getting more TMS when it does is common in real-world practice.
For a deeper look at how long benefit tends to last, see how long does TMS last. If you are watching for early warning signs, our guide to signs of depression relapse after TMS lists what to look for.
Retreatment vs. maintenance vs. a new approach
These get mixed up, and insurers treat them differently.
| What it is | Typical insurance view | |
|---|---|---|
| Retreatment (second course) | A new acute course after symptoms return | Often covered if you responded the first time and meet criteria |
| Maintenance / booster | Occasional sessions after a course to try to prevent relapse | Often not covered |
| Extension of a course | A few more sessions at the end of the original course | Plan-dependent; usually needs documentation |
On maintenance, the plans we reviewed are blunt. Iowa Medicaid says “maintenance therapy is considered not medically necessary as there is insufficient evidence to support this treatment at the present time” (Iowa Medicaid policy THR-001). Moda Health writes that, due to the paucity of high-quality evidence, “maintenance TMS is generally considered to be experimental/investigational,” while noting that patients who respond and later relapse “may benefit from reintroduction” (Moda Health). Our guides on maintenance TMS and booster sessions explain the clinical side.
If your first course did not help at all, a repeat of the same protocol is a different conversation. See what to do when TMS isn’t working for options like changing the protocol or coil.
What insurers typically ask for
We read published policies from a few payers. They are not identical, but the themes repeat. These are examples, not a promise of what yours will require.
- Medicare. A Carelon form that summarizes the Medicare LCD (L37086) says retreatment may be considered when a patient met the initial-treatment guidelines, then relapsed, and “responded to prior treatments as evidenced by a greater than 50% improvement” on a standard rating scale (Carelon form).
- Iowa Medicaid. Retreatment is considered medically necessary when current symptoms have worsened by 50 percent from the prior best PHQ-9 score, the prior response was a 50 percent or greater reduction from baseline, and there are no contraindications.
- Montana Medicaid. Repeat acute treatment for relapse requires continued stay review, and the member should have responded to the prior treatment with a greater than 50 percent improvement on a standard scale (Montana Policy 475).
- Moda Health (commercial). Reintroduction criteria include a response of 50% or better to the earlier course, enough time passed to establish a meaningful increase in symptoms, symptoms worsened by 50% or more from peak response on the same scale, and other treatments like therapy or medication used alongside.
- Medi-Cal plans. The Carelon Medi-Cal form says InterQual criteria expect the previous TMS to have occurred at least six months earlier.
The pattern: your insurer wants proof that TMS worked for you, proof that you relapsed and a reason to believe a repeat will help. That proof is almost always a standardized score, so the PHQ-9 numbers from your first course matter. If you did not track them, ask your clinic whether they kept your baseline and end-of-course scores. Our guide to tracking progress with the PHQ-9 shows how to keep your own record from now on.
How soon can you start again?
There is no single national rule. Some payers set a minimum interval, as with that six-month Medi-Cal expectation. Others say only that “sufficient time” must pass. Clinically, the key question is whether your symptoms have returned in a meaningful, lasting way rather than a rough patch. Your psychiatrist can use a PHQ-9 or similar scale to help tell the difference.
If you have a bad stretch within a few weeks of finishing, ask about the options your clinic offers short of a full new course. Do not wait if you are in crisis. If you are having thoughts of harming yourself, call or text 988 (the Suicide and Crisis Lifeline) or go to your nearest emergency room.
Steps to take if symptoms are coming back
- Tell your prescriber early. Earlier action is easier to document and easier to treat.
- Take a fresh PHQ-9 and keep the date. Compare it to your best score from the first course.
- Call the TMS clinic. Ask whether they have your first-course records and what a repeat course would involve.
- Call your insurer with your clinic’s information. Ask whether a repeat course needs new prior authorization, whether there is a waiting period and whether a limit on courses applies. Our call script and question list can help.
- Ask about the full picture. Medication changes, therapy and other options can work alongside TMS. See combining TMS with therapy.
- Plan for the paperwork. A second course almost always needs a fresh authorization.
If the plan denies the request, you can appeal; see our guide to TMS insurance appeals.
Finding a clinic for a second course
You can go back to the same clinic or choose another. Staying with the same clinic means your records and mapping history are on file, but a new clinic may offer a different protocol, such as theta burst. Search clinics near you and ask what they need from your first course before booking. If you are weighing whether to try TMS for the first time, the candidate quiz is a good place to start.
Frequently asked questions
Can you do TMS twice?
Yes. People who respond to a first TMS course and later relapse can have a second acute course. A 2026 multi-center study found that 82.5% of 177 prior responders responded again, though it was a retrospective study without a control group.
Is the second TMS course as effective as the first?
Not necessarily the same, but the evidence is encouraging. In the 2026 study, responders reached response earlier in the second course (median session 12 vs. 16 on the PHQ-9). Individual results vary, and the study could not show cause and effect.
Does insurance cover a second course of TMS?
Often, yes, if you meet the plan’s retreatment criteria, but it usually needs new authorization. Plans commonly want proof of a meaningful response the first time, such as a drop of 50% or more on a rating scale, and a documented return of symptoms.
How long do I have to wait between TMS courses?
It depends on the plan. Some set no fixed gap, while at least one Medi-Cal form we reviewed expects the prior treatment to have ended six or more months before. Ask your insurer for its exact rule.
Will insurance pay for TMS maintenance sessions?
Often not. Iowa Medicaid and Moda Health, for example, both describe maintenance TMS as not medically necessary or experimental. Ask your plan, and see our maintenance TMS guide.
What if my first TMS course didn’t work?
A second course of the same treatment is a different question. Talk to your psychiatrist about changing the protocol, trying a different coil or exploring other treatments. Our post on when TMS isn’t working walks through options.
