Does TMS generate large profit?

[annoyedpsychiatrist]

Just curious because of how popular it is these days, every private office seems to have one. Not familiar with billing/reimbursement for it.

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[littlefred]

Just curious because of how popular it is these days, every private office seems to have one. Not familiar with billing/reimbursement for it.

General principle but... procedures = more reimbursement.

One of the few that psychiatrists actually do, the issue is that tou might need multiple machines. 1 session can take 30 to 45 minutes so it is limited by that.

 

[TexasPhysician]

Think of TMS more like an esthetics machine from a financial perspective. If you have enough patients to fill the day with TMS patients, the machine can be quite financially rewarding. The problem is that the majority of clinics can’t fill the machine with patients. Then it becomes expensive office decor.

 

[Merovinge]

Keep in mind that courses of the current TMS are very time/cycle intensive. You go 5 days/week for several weeks so it results in absurd number of visits compared to any other type of mental health treatment. I haven't reviewed the literature, but I wouldn't be surprised if behavioral activation made up the bulk of the benefit. Supposedly going for a walk prior to treatment enhances the effect, huge shocker there.

 

[comp1]

I definitely agree that the primary benefit is getting the person out of the house five days a week even if there is some marginal benefit over sham treatments. In terms of profit, sure, of course. It has high reimbursement rates.

 

[smalltownpsych]

It is important to make sure that you have enough patients that would be willing or able to do the five days a week thing. A number of family practice NPs around here bought the machines and then found out that their depressed patients really weren’t that depressed and hence not that motivated to do something that intensive. Heck, most of the people who present with depressive symptoms in primary care aren’t even motivated enough to show up to see me for psychotherapy once a week.

 

[Sushirolls]

The other issue is some pubs supporting, theta burst protocol? which can be done in 3 minutes sessions and complete in 5 days.

So if the course of remission is faster, this means less ongoing treatments, and the machine needs a higher volume to justify it. But I suspect current clinics aren't chomping at the bit to do a faster protocol.

I've thought about it a few times, but I just don't have the volume to justify a machine.

 

[Merovinge]

I mean if theta burst goes on to replicate at anything resembling the initial Stanford work, a lot of modern mental health treatment is going to be rendered irrelevant. Definitely need a healthy dose of skepticism for something like what they are purporting, especially as it seems to have fallen off the news cycle which would be odd for something with great convenience and profound benefit to risk ratio.

 

[Sushirolls]

These days, just because something falls off the news cycle doesn't mean it isn't news worthy.
I'm not on top of TMS articles enough to know where things stand if theta really is the direction treatments should go and its being neglected with intent or if not yet proven itself or was a flop. As I hope that professionalism still has a core, a beating heart that lives, deep in medicine, I hope that it isn't being neglected for business reasons.

 

[psycho-matic]

The other issue is some pubs supporting, theta burst protocol? which can be done in 3 minutes sessions and complete in 5 days.

So if the course of remission is faster, this means less ongoing treatments, and the machine needs a higher volume to justify it. But I suspect current clinics aren't chomping at the bit to do a faster protocol.

I've thought about it a few times, but I just don't have the volume to justify a machine.

Is that what this is? They claim they are first in the nation to offer the SAINT protocol.

UAMS First in Nation to Offer Groundbreaking Therapy for Treatment-Resistant Depression - UAMS News

LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) is the first medical facility in the United States to provide an innovative therapeutic treatment for major depressive disorder (MDD).

news.uams.edu

 

[DOswag]

Love tms and seeing the results with patients. We currently have 2 chairs and are moving to a new office soon where the plan is to expand chairs, think the goal is to eventually get 4-5.

 

[brosa]

Love tms and seeing the results with patients. We currently have 2 chairs and are moving to a new office soon where the plan is to expand chairs, think the goal is to eventually get 4-5.

That is fantastic. Any advice or insight on how you guys did that? Seems that some people have trouble filling one, but you are planning on getting 5. On a similar note, has anyone ever run the numbers on how many patients weekly on TMS you need to pay off the machine?

 

[DOswag]

That is fantastic. Any advice or insight on how you guys did that? Seems that some people have trouble filling one, but you are planning on getting 5. On a similar note, has anyone ever run the numbers on how many patients weekly on TMS you need to pay off the machine?

I don't have much insight into how the group I work with actually did this by the numbers but our exec team does keep up with this in detail for each clinic. Work for a company/clinic/group (whatever you want to call it) that has clinics in multiple states, started officially in 2017 in AZ and has expanded since then. The clinics that have been established for longer have several TMS chairs, most offices that they open in new locations start with just one. They do have team members that they hire to go out to primary care offices, OB clinics etc to establish a referral base and promote that we do offer TMS and ketamine treatments on top of medication management for patients and educate outside providers about TMS as well which really helps an upstarting clinic gain patients. We often have patients that come to us saying they've tried x number of meds and are interested in TMS as they have been provided some amount of information on it. If someone calls to make an appointment, our schedulers also educate people briefly over the phone about TMS, how it works etc.

 

[mistafab]

TMS is a huge money maker if you keep it up with volume. Your biggest limiter is pipeline - I.e. finding people it can help. The RVU you get after a map session and turning it over to techs and nurses is insane. You can churn through and treat huge amounts of TRD which is needed in almost any metro

 

[MedMan80]

TMS Therapy, Psychiatry & Primary Care - Depression Treatment | Salience Health. see this practice in TX

I think they rack it up with TMS.

 

[TexasPhysician]

TMS Therapy, Psychiatry & Primary Care - Depression Treatment | Salience Health. see this practice in TX

I think they rack it up with TMS.

There are some companies in Texas that really push TMS and likely make good $$. They have FT marketers on staff. They heavily advertise TMS. It is a niche business, not an outpatient psych practice. Think $10K+ advertising per month.

I’m not saying you couldn’t replicate this, but most generic psych practices are not a good fit. You need to plan to market and advertise heavily or have a team of psychiatrists/midlevels in the practice doing internal referrals.

 

[MedMan80]

absolutely, i just wanted to share an example of how some places bank from it.

 

[manly_man246]

I don't have much insight into how the group I work with actually did this by the numbers but our exec team does keep up with this in detail for each clinic. Work for a company/clinic/group (whatever you want to call it) that has clinics in multiple states, started officially in 2017 in AZ and has expanded since then. The clinics that have been established for longer have several TMS chairs, most offices that they open in new locations start with just one. They do have team members that they hire to go out to primary care offices, OB clinics etc to establish a referral base and promote that we do offer TMS and ketamine treatments on top of medication management for patients and educate outside providers about TMS as well which really helps an upstarting clinic gain patients. We often have patients that come to us saying they've tried x number of meds and are interested in TMS as they have been provided some amount of information on it. If someone calls to make an appointment, our schedulers also educate people briefly over the phone about TMS, how it works etc.

I think I interviewed w/ this company or at least one like it (AZ/UT/TX, expanding rapidly, has a name that sounds like peace and tranquility). High vol, they wanted to max out TMS referrals but also packed in the outpatient schedule 20-30 a day, the spreadsheet they sent along for how the MD could earn $500k+ included billing 90833 on about half of the f/u cases. They were also "branching out" into ADHD. Felt sketch AF.

 

[DOswag]

I believe that is the one you interviewed at lol. My honest opinion is I have had nothing but a positive experience working for them. Granted my only previous experience to compare it to is 4 years as a psychiatrist in the Air Force and residency prior to that so, it's exponentially better than working in milmed. I work 4 days per week 10 hr days, typically see anywhere from 15-20ish patients which keeps me busy. I think the most I've ever seen in a day is 23-24 which is on a day when I just happen to have mostly follow ups scheduled in the day without any intakes but I do typically have a no show or 2 on most days. Never seen 30 patients in a day and I've been here a year now. There is somewhat of a push or should I say, incentive to get patients in to TMS but it does works very well for patients and side effects are less than meds. But there are plenty of psychiatrists that work for them that don't use it as much as others so it's not problematic if someone doesn't necessarily refer patients that often for it. Great support, again exponentially better than anything I experienced in the Air Force. I get a 3 day weekend every weekend, no nights, weekends, or call. I'm not sure what "branching out into ADHD" means though. We see patients that have ADHD but that's not like a main focus of the practice. I've seen people post on here that they had a similar sentiment of it being sketchy for some reason, but I've really enjoyed my time here so far. It is possible to make 500K and there are some that exceed that but most are around 350-400. I'm on pace for about 400K in my first year here so I'm not complaining. Way more than I ever made active duty.

 

[calvnandhobbs68]

I think I interviewed w/ this company or at least one like it (AZ/UT/TX, expanding rapidly, has a name that sounds like peace and tranquility). High vol, they wanted to max out TMS referrals but also packed in the outpatient schedule 20-30 a day, the spreadsheet they sent along for how the MD could earn $500k+ included billing 90833 on about half of the f/u cases. They were also "branching out" into ADHD. Felt sketch AF.

If you're doing 10 hour days like this guy, 20 patients a day is every 30 minutes. About 50% 90833s for 30 minute followups is probably typical if not low if you're actually spending 25-30min on appts.

 

[DOswag]

I'm happy where I'm at currently but was ready for pretty much anything after the military as I assumed it couldn't get worse than that. But I've had a great experience where I work so far and not planning to leave at this time.

 

[brosa]

I believe that is the one you interviewed at lol. My honest opinion is I have had nothing but a positive experience working for them. Granted my only previous experience to compare it to is 4 years as a psychiatrist in the Air Force and residency prior to that so, it's exponentially better than working in milmed. I work 4 days per week 10 hr days, typically see anywhere from 15-20ish patients which keeps me busy. I think the most I've ever seen in a day is 23-24 which is on a day when I just happen to have mostly follow ups scheduled in the day without any intakes but I do typically have a no show or 2 on most days. Never seen 30 patients in a day and I've been here a year now. There is somewhat of a push or should I say, incentive to get patients in to TMS but it does works very well for patients and side effects are less than meds. But there are plenty of psychiatrists that work for them that don't use it as much as others so it's not problematic if someone doesn't necessarily refer patients that often for it. Great support, again exponentially better than anything I experienced in the Air Force. I get a 3 day weekend every weekend, no nights, weekends, or call. I'm not sure what "branching out into ADHD" means though. We see patients that have ADHD but that's not like a main focus of the practice. I've seen people post on here that they had a similar sentiment of it being sketchy for some reason, but I've really enjoyed my time here so far. It is possible to make 500K and there are some that exceed that but most are around 350-400. I'm on pace for about 400K in my first year here so I'm not complaining. Way more than I ever made active duty.

Are they hiring remote psychiatrists? You got me interested lol. I tried finding the name of the company but not sure if I am looking at the right one.

 

[DOswag]

Are they hiring remote psychiatrists? You got me interested lol. I tried finding the name of the company but not sure if I am looking at the right one.

sent you a pm

 

[MedMan80]

sent you a pm

Can you CC me as well?

 

[DOswag]

Can you CC me as well?

Sent you an invite

 

[Justice1071]

I was able to observe TMS for the first time last week. While in there I saw a sheet detailing how much it would be for Self-Pay for the initial treatment (I think 5 days per week, 20 minutes per treatment, for a month). The total was 20-21k for this place.
Of course, that's most likely not what insurance pays. But still pretty pricey.

 

[newpsych1]

Love tms and seeing the results with patients. We currently have 2 chairs and are moving to a new office soon where the plan is to expand chairs, think the goal is to eventually get 4-5.

I am looking to add TMS to my practice (a newly started practice) and came across your comment. I decided to reach out as I am looking for the right machine. I am hoping to decide on one that will be of benefits to my patients as I have heard some may not be as comfortable or effective as others. Could you kindly tell me the name and model of the TMS machine you use at your place of work?
I am located in TX.

 

[Gubernac]

That is fantastic. Any advice or insight on how you guys did that? Seems that some people have trouble filling one, but you are planning on getting 5. On a similar note, has anyone ever run the numbers on how many patients weekly on TMS you need to pay off the machine?

Here's their model: you are encouraged to bill 99215 at EVERY appointment, they justify this by saying that you are determining if somebody should go to the hospital or on every appointment deeming it "high risk". The guy giving me the tour opened by saying, "we don't take any substance abuse, no medicare/medicaid... we weed out all the riff raff". Not taking medicare/medicaid may be the only reason that the **** hasn't hit the fan yet on this very young company that is clearly encouraging fraud. You are essentially entirely compensated by how many patients you get to do TMS. The owner walks you through his excel sheet where the assumption are that every TMS patient (in addition to billing 99215) is also getting ketamine. It felt like a recruitment meeting for summer sales. The guy explains you will succeed in this model, "if you believe in yourself." He asks, "are you an A, B, or C psychiatrist... maybe an F?" he goes on to explain that an F is 50th percentile earner in his company, and an A is 90th percentile earner in his company. They legitimately believe every person walking through their doors should be getting TMS or diagnosis should be changed to reflect getting TMS. Aside from all that, the interview was absolutely bat**** ****ing crazy... tons of alt-right rhetoric from the top earning physician and his wife. At one point made the comment that we should just kill all homeless people, said welfare shouldn't exist because it "robs churches from the opportunity to serve people", nobody at the dinner table with a dissenting view besides me. The place is scammy AF and the top guy is such a slimy POS.

That said, I imagine you can find your own way to practice ethically, but I wouldn't expect to make bank in the process on their financial model. I am not at all assuming that DOswag is doing anything unethical, but my entire experience interacting with them was disgusting.

 

[MedMan80]

I also had a bad feeling about a TMS place i interviewed at in TX. Basic salary was below average with an expectation to do lots of TMS, incentives with TMS and supervision pushed one to beyond average. I basically felt like one would be a salesman with the role and declined the position.

 

[calvnandhobbs68]

I mean when you're paid by how many times you use your hammer, suddenly everything starts looking like a nail.

 

[mistafab]

Here's their model: you are encouraged to bill 99215 at EVERY appointment, they justify this by saying that you are determining if somebody should go to the hospital or on every appointment deeming it "high risk". The guy giving me the tour opened by saying, "we don't take any substance abuse, no medicare/medicaid... we weed out all the riff raff". Not taking medicare/medicaid may be the only reason that the **** hasn't hit the fan yet on this very young company that is clearly encouraging fraud. You are essentially entirely compensated by how many patients you get to do TMS. The owner walks you through his excel sheet where the assumption are that every TMS patient (in addition to billing 99215) is also getting ketamine. It felt like a recruitment meeting for summer sales. The guy explains you will succeed in this model, "if you believe in yourself." He asks, "are you an A, B, or C psychiatrist... maybe an F?" he goes on to explain that an F is 50th percentile earner in his company, and an A is 90th percentile earner in his company. They legitimately believe every person walking through their doors should be getting TMS or diagnosis should be changed to reflect getting TMS. Aside from all that, the interview was absolutely bat**** ****ing crazy... tons of alt-right rhetoric from the top earning physician and his wife. At one point made the comment that we should just kill all homeless people, said welfare shouldn't exist because it "robs churches from the opportunity to serve people", nobody at the dinner table with a dissenting view besides me. The place is scammy AF and the top guy is such a slimy POS.

That said, I imagine you can find your own way to practice ethically, but I wouldn't expect to make bank in the process on their financial model. I am not at all assuming that DOswag is doing anything unethical, but my entire experience interacting with them was disgusting.

I also had a bad feeling about a TMS place i interviewed at in TX. Basic salary was below average with an expectation to do lots of TMS, incentives with TMS and supervision pushed one to beyond average. I basically felt like one would be a salesman with the role and declined the position.

I had the exact same experience with a place in TX. Their numbers all rosy, 99215 every visit, everyone gets TMS and ketamine.

I'm 99% sure we interviewed at the same place. Or possibly, a handful of TMS private practices are run in this similar, fraudulent manner.

 

[brosa]

I interviewed with them too, and had the same feelings. I looked at the excel sheet and noticed every calculation was with 99215. Seems that it gets sketchyer as you proceed with the interviews. Quite interesting lol

 

[littlefred]

Why are people afraid to say it's Serenity Healthcare?

 

[clausewitz2]

I had the exact same experience with a place in TX. Their numbers all rosy, 99215 every visit, everyone gets TMS and ketamine.

I'm 99% sure we interviewed at the same place. Or possibly, a handful of TMS private practices are run in this similar, fraudulent manner.

There's an outfit in my neck of the woods that appears to have a very similar model and whose website gives off a fairly scummy vibe, so it is possibly more than a handful. I am very far from Texas.

 

[psydocc]

I had the exact same experience with a place in TX. Their numbers all rosy, 99215 every visit, everyone gets TMS and ketamine.

I'm 99% sure we interviewed at the same place. Or possibly, a handful of TMS private practices are run in this similar, fraudulent manner.

This was my exact experience with Serenity. TMS + ketamine for everyone and all follow ups (20 minute follow ups btw) were expected to be 99215 + 90833. I laughed when I saw the numbers on the spreadsheet. With the way they calculate compensation, you could see over 400 "99215" + 90833 patients per month and still make less than $200,000 for the year if your TMS numbers aren't good enough...

 

[clausewitz2]

This was my exact experience with Serenity. TMS + ketamine for everyone and all follow ups (20 minute follow ups btw) were expected to be 99215 + 90833. I laughed when I saw the numbers on the spreadsheet. With the way they calculate compensation, you could see over 400 "99215" + 90833 patients per month and still make less than $200,000 for the year if your TMS numbers aren't good enough...

In my neck of the woods this would gross something like 750k+, that is beyond highway robbery.

 

[Kr#36]

This was my exact experience with Serenity. TMS + ketamine for everyone and all follow ups (20 minute follow ups btw) were expected to be 99215 + 90833. I laughed when I saw the numbers on the spreadsheet. With the way they calculate compensation, you could see over 400 "99215" + 90833 patients per month and still make less than $200,000 for the year if your TMS numbers aren't good enough...

Don't know if they changed the model but they recently offered a base guarantee of 400k. Requires 1 Saturday per month and mid level supervision though.

 

[shoomer]

Don't know if they changed the model but they recently offered a base guarantee of 400k. Requires 1 Saturday per month and mid level supervision though.

Base guarantee is new if that's true. I definitely heard them use 400k as a number that could be achieved, but the base guarantee was something below 250k back when I spoke to them in the fall; 1 Saturday was a requirement too. You needed to get a good amount of full TMS + ketamine completions to get those numbers.

 

[Gubernac]

Don't know if they changed the model but they recently offered a base guarantee of 400k. Requires 1 Saturday per month and mid level supervision though.

definitely would have been new to me too. I was given 2??K as base last fall

 

[DOswag]

This was my exact experience with Serenity. TMS + ketamine for everyone and all follow ups (20 minute follow ups btw) were expected to be 99215 + 90833. I laughed when I saw the numbers on the spreadsheet. With the way they calculate compensation, you could see over 400 "99215" + 90833 patients per month and still make less than $200,000 for the year if your TMS numbers aren't good enough...

I've never had to work on saturday, never been asked to. I work mon-thur 10 hrs with every friday off. The base pay is low for sure (when I first was even looking at the job I was kind of concerned about this), but it is pretty easy to make above the base salary with the bonus structure. Yes there is incentive to utilize TMS, but it works very well for depression and other things such as comorbid anxiety (other protocols that can be added in treatment as well such as migraines, cognition etc). Had plenty of patients come back and report significant improvement after TMS treatment that was never achieved with a laundry list of medications and side effects, + therapy. I don't order TMS + ketamine for everyone and all follow ups, I don't bill 99215 for all follow ups as was mentioned above. Even if you don't order a single TMS treatment, you will not make below the base salary which is slightly above $200K. I feel VERY supported to do my job of seeing patients and documentation but the staff takes care of literally all other ancillary things such as billing, paperwork such as PA's, FMLA, phone calls etc. I enjoy what I do and seeing patients get better with the TMS and ketamine treatments. If I feel the patient could benefit from the treatment I discuss it with them as an option but many just say "no thanks" and I never mention it again. I made well above the base salary this year working 40 hrs per week, rarely leave work more than 10 minutes after my last patient, plenty of time to spend with my family. Some psychiatrist put a lot of TMS orders in, some hardly put any in at all. I've pretty much only had positive experiences with this company.

 

[calvnandhobbs68]

I've never had to work on saturday, never been asked to. I work mon-thur 10 hrs with every friday off. The base pay is low for sure (when I first was even looking at the job I was kind of concerned about this), but it is pretty easy to make above the base salary with the bonus structure. Yes there is incentive to utilize TMS, but it works very well for depression and other things such as comorbid anxiety (other protocols that can be added in treatment as well such as migraines, cognition etc). Had plenty of patients come back and report significant improvement after TMS treatment that was never achieved with a laundry list of medications and side effects, + therapy. I don't order TMS + ketamine for everyone and all follow ups, I don't bill 99215 for all follow ups as was mentioned above. Even if you don't order a single TMS treatment, you will not make below the base salary which is slightly above $200K. I feel VERY supported to do my job of seeing patients and documentation but the staff takes care of literally all other ancillary things such as billing, paperwork such as PA's, FMLA, phone calls etc. I enjoy what I do and seeing patients get better with the TMS and ketamine treatments. If I feel the patient could benefit from the treatment I discuss it with them as an option but many just say "no thanks" and I never mention it again. I made well above the base salary this year working 40 hrs per week, rarely leave work more than 10 minutes after my last patient, plenty of time to spend with my family. Some psychiatrist put a lot of TMS orders in, some hardly put any in at all. I've pretty much only had positive experiences with this company.

You do realize 200K for 40hrs/week is ridiculously low outside of academics right? So yes, you're getting absolutely hosed if that's your base without referring people to ketamine or TMS.

Also, honestly if you're getting bonuses based off referrals to specific treatments I'd be very aware of what your state medical kickback and self-referral laws are.

 

[ObsequiousAplomb]

You do realize 200K for 40hrs/week is ridiculously low outside of academics right? So yes, you're getting absolutely hosed if that's your base without referring people to ketamine or TMS.

Also, honestly if you're getting bonuses based off referrals to specific treatments I'd be very aware of what your state medical kickback and self-referral laws are.

Do pain management doctors have to worry about self-referrals for procedures? They certainly make more money off of the procedures they do, and many have worse evidence bases than TMS/ketamine.

I was under the impression they meant that the bonuses were RVU/productivity based. It would be a frustrating world if self-referring for a standard procedure and getting paid more for doing the more intensive treatment were viewed unfavorably.


Though of course $200k is getting fleeced. I'd make that much at 12 hours/week.

 

[calvnandhobbs68]

Do pain management doctors have to worry about self-referrals for procedures? They certainly make more money off of the procedures they do, and many have worse evidence bases than TMS/ketamine.

I was under the impression they meant that the bonuses were RVU/productivity based. It would be a frustrating world if self-referring for a standard procedure and getting paid more for doing the more intensive treatment were viewed unfavorably.


Though of course $200k is getting fleeced. I'd make that much at 12 hours/week.

They definitely do. This stuff actually does come up all the time with referrals for imaging and procedures.

If they're referring for someone else to do the TMS or ketamine, it can't be RVU based because they aren't the one billing for the RVUs. It could fairly easily be construed as fee splitting or incentivizing referrals for a specific procedure to another physician if compensation is tied to this.

Stark laws and federal anti-kickback laws (which are two separate things) only apply to Medicare and other federal health programs but specific states also have self-referral or more restrictive kickback laws. You're usually covered under the "Referrals for physician services within the group exception" but the business structure of the group actually does matter with this stuff to make sure it's actual internal services within one practice and you're not separate business entities.

The Stark Truth About the Stark Law: Part II

Find out whether one or more of the many exceptions to the Stark statute apply to you.

www.aafp.org

 

[ObsequiousAplomb]

They definitely do. This stuff actually does come up all the time with referrals for imaging and procedures.

Stark laws and federal anti-kickback laws (which are two separate things) only apply to Medicare and other federal health programs but specific states also have self-referral or more restrictive kickback laws. You're usually covered under the "Referrals for physician services within the group exception" but the business structure of the group actually does matter with this stuff to make sure it's actual internal services within one practice and you're not separate business entities.

The Stark Truth About the Stark Law: Part II

Find out whether one or more of the many exceptions to the Stark statute apply to you.

www.aafp.org

Wow. I'm so glad to not work in a setting that could be questionable like that. Thank you for the information.

 

[Kr#36]

definitely would have been new to me too. I was given 2??K as base last fall

I ended up finding out: it turns out the 400k base guarantee only applies to Dallas and Houston

 

[psydocc]

They definitely do. This stuff actually does come up all the time with referrals for imaging and procedures.

If they're referring for someone else to do the TMS or ketamine, it can't be RVU based because they aren't the one billing for the RVUs. It could fairly easily be construed as fee splitting or incentivizing referrals for a specific procedure to another physician if compensation is tied to this.

Stark laws and federal anti-kickback laws (which are two separate things) only apply to Medicare and other federal health programs but specific states also have self-referral or more restrictive kickback laws. You're usually covered under the "Referrals for physician services within the group exception" but the business structure of the group actually does matter with this stuff to make sure it's actual internal services within one practice and you're not separate business entities.

The Stark Truth About the Stark Law: Part II

Find out whether one or more of the many exceptions to the Stark statute apply to you.

www.aafp.org

The TMS is RVU based and this was another thing I had an issue with. They told me that the TMS was fully done by their techs, including mapping/remapping, so it was touted as requiring "no effort" on my part. Maybe I'm wrong but I was always under the impression that insurance doesn't allow techs to perform TMS mapping.

 

[shoomer]

The TMS is RVU based and this was another thing I had an issue with. They told me that the TMS was fully done by their techs, including mapping/remapping, so it was touted as requiring "no effort" on my part. Maybe I'm wrong but I was always under the impression that insurance doesn't allow techs to perform TMS mapping.

I believe that's machine dependent. The TMS machine I've used is NeuroStar, which has a physician do the mapping. I think they use BrainsWay, which is more hands-off so the physicians are not involved. I was interested in actually doing the mapping myself and they did not entertain that.

 

[Stagg737]

I believe that's machine dependent. The TMS machine I've used is NeuroStar, which has a physician do the mapping. I think they use BrainsWay, which is more hands-off so the physicians are not involved. I was interested in actually doing the mapping myself and they did not entertain that.

Not sure if it's a requirement nationally, but where I'm at uses BrainsWay and physicians are required for mapping.