rTMS FAQs

How is rTMS different from ECT (Electro Convulsive Therapy)?

The two treatments are very different:

• rTMS treatment does not require anaesthesia
• rTMS treatment does not require sedation
• rTMS treatment does not produce a medically induced seize
• rTMS therapy has a milder side effect profile
• rTMS sessions are longer in duration and require more sessions in a treatment course

Medicare and rTMS

From 1 November 2021, rTMS therapy will be listed on the Medicare Benefits Schedule (MBS), with Medicare rebates available for eligible patients (explained below).

The Australian Government is providing funding of $288.5 million over the next four years to support this therapy. Around 90,000 patients are expected to benefit over this period.

Medicare will provide funding for an initial course of treatment and a course of retreatment, but not for longer-term maintenance treatment.

Who is eligible to receive Medicare-funded rTMS services?

Firstly, you must be eligible for Medicare. You must also meet the following criteria:

• Be at least 18 years of age;
• Be diagnosed with major depressive episode;
• Have failed to receive satisfactory improvement for the major depressive episode despite the adequate trialling of at least two different classes of antidepressant medications, unless contraindicated;
• Have also undertaken psychological therapy unless inappropriate; and
• Have not received rTMS treatment previously in either a public or private setting. You should speak to your psychiatrist about whether rTMS might be of benefit to you, and whether you would be eligible for Medicare-funded services.

How many rTMS treatment services will be funded through Medicare?

If you are eligible, Medicare rebates will be available for:

• Up to 35 rTMS services for an initial course of treatment; and
• Up to 15 rTMS services for a course of retreatment.

A course of retreatment may be undertaken where there has been a relapse after at least four months, and where the initial course of treatment has been successful. Before commencing your first treatment session, your psychiatrist will plan how the treatment is to be provided including the dosage (as part of a ‘prescription and mapping’ service). A further prescription and mapping service will be required before commencing a course of retreatment. Both of these services will also attract a Medicare rebate

Why are Medicare rebates not available for patients who have previously received rTMS treatment, or for ongoing maintenance treatment?

The Government has followed the advice of the Medical Services Advisory Committee (MSAC) on these issues. MSAC is an independent, expert advisory group which provides advice to Government on whether new medical services should be publicly funded, based on an assessment of comparative safety, clinical effectiveness and cost-effectiveness, using the best available evidence. Based on MSAC’s advice to Government, Medicare rebates will be available for the initial course of treatment and one course of retreatment services over a patient’s lifetime. MSAC supported the listing of rTMS for patients who have not previously received rTMS treatment. MSAC also considered the use of rTMS as a maintenance treatment for major depressive disorder. MSAC found that, compared to initial treatment and retreatment courses, there was a limited evidence base for maintenance treatment.

Is there any discretion to increase the number of Medicare-funded rTMS treatment services to a patient?

No. The Medicare regulations allow a maximum of 50 treatment services (35 services initially and a further 15 services if clinically appropriate) over a person’s lifetime.

Who can provide Medicare-funded rTMS services?

Medicare-funded rTMS treatment can only be provided by a psychiatrist, or a heath care professional on behalf of a psychiatrist, who has undertaken rTMS training. A health care professional may include a nurse practitioner, practice nurse or an allied health professional who has undertaken rTMS training.

Where Medicare-funded rTMS treatment is provided as part of hospital treatment, can a patient also receive private health insurance benefits to cover hospital accommodation and other services?

Yes, but your psychiatrist will need to certify that rTMS treatment as an admitted patient is clinically necessary in your circumstances. You should speak to your psychiatrist, private hospital and health fund about what fees will be charged, and what benefits are payable, before commencing treatment.

Can patients receive privately-funded treatment after 1 November 2021 if they are not eligible for Medicare-funded rTMS services?

Yes. If you are not eligible for Medicare-funded rTMS services, you can continue to access privately-funded treatment. If you have private health insurance, you should speak to your health fund about what private health benefits would apply under your policy

Where can Medicare-funded rTMS services be provided?

While it is expected that most rTMS services will be provided as out-of-hospital treatment (for example, in an rTMS clinic or in a psychiatrist’s consultation room), some patients may require hospital treatment as an inpatient. Your psychiatrist will assess where it is best for you to receive rTMS treatment

How much is the Medicare rebate?

The amount of the Medicare rebate will depend on where you receive rTMS services.

If provided as part of out-of-hospital treatment (outpatient or in consulting rooms), the Medicare rebate will be $136 for each treatment service, and $158.45 for each prescription and mapping service. The rebate is 85% of the Medicare schedule fee*.

If provided as part of hospital treatment (inpatient), the Medicare rebate will be $120 for each treatment service, and $139.80 for each prescription and mapping service. The rebate is 75% of the Medicare schedule fee. Private health insurance benefits may also apply (25% of the Medicare schedule fee*).

If you have reached the annual threshold for the Extended Medicare Safety Net, you may be eligible to receive a higher Medicare rebate for out-of-hospital treatment depending on what your psychiatrist charges for the service. Further information about the Extended Medicare Safety Net is available from the Services Australia website.

* Medicare Schedule fee is $160.00 for each treatment service and $186.40 for the prescription and mapping service.

Last updated: 25 October 2021

How will rTMS help me?

The potential benefit of rTMS for you is that it may lead to an improvement in your mental health condition. rTMS has been shown to be a highly effective treatment for a number of conditions however, not all patients respond equally well. As with all forms of medical treatment, some patients recover quickly, others recover only to relapse again and require further treatment, while others may not respond at all. It may take up to two weeks after the rTMS treatment is completed before symptom improvement occurs although most patients report an improvement within the course of the treatments. Some patients may also require further follow up treatments.

What will actually happen to me when I have rTMS?

Before treatment begins, the psychiatrist who is prescribing your rTMS will need to identify the correct placement of the magnets on your head and the prescribed dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes. During this appointment:

• You will be taken to a treatment room, asked to sit in a reclining chair and given earplugs to wear during the procedure.
• An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You will also feel a tapping sensation on your forehead. This part of the process is called mapping.
• The psychiatrist who is prescribing your rTMS will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.

The rTMS psychiatrist will then issue a prescription for future treatment sessions, which will be adhered to by the rTMS treatment Credentialed Clinician.

During each subsequent treatment you are seated in a comfortable chair. You are fully conscious and responsive. There are no medications involved in the treatment. The rTMS clinician positions the magnet over the appropriate area of the scalp as prescribed by the psychiatrist and activates the magnet.

You will need to remove any metal hair clips, earrings and studs, glasses and hearing aids during your treatment. For ease of treatment it is preferable that you do not have gel, mousse or other products in your hair.

During treatment, you hear a clicking sound and feel a tapping sensation on your head. Many patients will be able to listen to music, watch television, read a magazine or talk to the credentialed mental health clinician who stays with you during the treatment. The procedure will take between 20 – 40 minutes, depending on your specific prescription.

At the end of the treatment you can return to your usual routine activities, including driving your car.

How many treatments will I need?

The number of treatments that you will have depends on your mental health condition, how quickly you respond to the treatment and the clinical judgement of your psychiatrist. rTMS is typically given 5-6 times a week for 20-30 treatments.

Treatment needs vary from individual to individual but typically your psychiatrist will prescribe maintenance treatment if your depression symptoms are returning.

Will rTMS service be bulk billed?

Like all Medicare services, bulk billing is at the discretion of the treating doctor. If the service is bulk billed, your psychiatrist is agreeing to accept the Medicare rebate as full payment. You cannot be charged any other costs such as booking, administration or record keeping fees.

Is a referral needed to receive rTMS services?

If you are currently under the care of a rTMS-trained psychiatrist, then you will not need another referral. If you don’t have a psychiatrist you see regularly, speak to your GP. You can discuss your symptoms and your GP can refer you to a psychiatrist if needed. They can contact the Royal Australian and New Zealand College of Psychiatrists (RANZCP) if they are not sure who to refer you to. The RANZCP website includes information about finding a psychiatrist

How to access rTMS

• To find out more and discuss the best options for you, please contact our team today by phoning 03 9549 6555.
  
• Alternatively, talk to your GP and request a referral for rTMS treatment as an outpatient today.
• Referrals can be submitted on our online GP/specialist admission referral form link below or emailed to [email protected].