TMS therapy for Boca Raton — outpatient TRD care, 20 minutes from home.

RECO Integrated Psychiatry's Delray Beach office is 11 miles up Federal Highway from Mizner Park — a 20-minute commute that keeps a six-week rTMS course inside a working schedule rather than requiring time off. The psychiatry team handles motor threshold mapping, prior authorization, and the standard 10 Hz DLPFC protocol at 120% MT in-office, with iTBS available for clients whose workday can't absorb a 45-minute daily appointment. No facility fee, no PHP enrollment, no interruption to employment.

From Mizner Park or Royal Palm Place, RECO Integrated Psychiatry’s Delray Beach office sits about eleven miles up Federal Highway — a 20-minute drive that keeps a six-week TMS course inside a normal workweek rather than turning it into a leave of absence. For adults in Boca Raton with treatment-resistant depression or OCD, that geography matters: the standard rTMS protocol requires daily attendance for several weeks, and a commute that outstrips the appointment itself derails adherence. Care is delivered in the outpatient psychiatry office — no PHP enrollment, no IOP schedule, no facility fee.

Insurance-covered TRD candidacy and how we document it

Every major commercial payer — Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS — reimburses repetitive TMS for major depressive disorder that meets treatment-resistant criteria. In practice, “treatment-resistant” means two documented adequate antidepressant trials at therapeutic dose for at least six weeks each, with confirmed adherence, plus a course of psychotherapy. Trials typically cited include sertraline, venlafaxine, bupropion, and an augmentation agent such as aripiprazole, lithium, or quetiapine. When the treatment history is scattered across primary care, a former psychiatrist, and a telehealth prescriber, the intake at RECO includes reconstructing that record — pharmacy fill history, chart requests, PHQ-9 trajectories where available — so the prior authorization packet reflects the actual course rather than a partial one.

The psychiatry team submits the auth in the format the payer specifies and manages the appeal if the first submission is denied. For OCD, the coverage pathway is narrower: deep TMS on the H7 coil is FDA-cleared for OCD when SSRI and CBT with exposure and response prevention have failed, and YBOCS scores are documented pre-treatment and at intervals. Payer response times run one to three weeks; scheduling begins on approval.

Motor threshold mapping and the first week

Session one is not a treatment session — it is motor threshold determination. The clinician positions the coil over the left motor cortex and delivers single pulses at descending intensity until the minimum stimulator output that reliably evokes a visible right-thumb twitch is identified. Treatment intensity is then set at 120% of that motor threshold. The coil is repositioned five to six centimeters anteriorly over the left dorsolateral prefrontal cortex, which is the antidepressant target.

Sessions two through five are acclimation. Scalp discomfort at the treatment site — sharp taps synchronized with each pulse — is most pronounced in the first week and typically fades as local tissue habituates. Superficial facial-muscle contraction is normal and not a sign of overstimulation. Clients drive themselves to and from appointments, return to work the same day, and require no sedation, monitoring, or driving restriction. Coffee, medication schedules, and normal caffeine intake do not need to change; benzodiazepine premedication is not indicated and is not part of the protocol.

Standard 10 Hz versus intermittent theta burst (iTBS)

The FDA-cleared standard protocol delivers 3,000 pulses per session at 10 Hz over the left DLPFC at 120% of motor threshold, 20 to 40 minutes per session, five days per week, for thirty acute sessions plus a six-session taper. Intermittent theta burst stimulation (iTBS) is an FDA-cleared alternative that delivered equivalent efficacy in the THREE-D trial in a three-minute session. For clients whose workday cannot absorb a 45-minute daily appointment — a common constraint for Boca professionals commuting to West Palm or Fort Lauderdale — iTBS makes the six-week course feasible.

Not every commercial plan reimburses iTBS at the standard-protocol rate, and some payers require documented failure of standard rTMS before authorizing iTBS. RECO’s psychiatry team confirms the specific plan’s iTBS policy before scheduling so the choice of protocol is not reversed after treatment starts. For OCD on the deep TMS platform, the protocol is different again: 20 Hz stimulation over the medial prefrontal and anterior cingulate cortex, preceded by a brief symptom-provocation exercise to activate the target circuit.

Response, taper, and the retreatment question

Published response rates for rTMS in treatment-resistant depression run 40 to 60% depending on the trial and the resistance definition; remission rates run 25 to 40%. Response typically emerges between sessions 15 and 25 — earlier than most oral antidepressants but not immediate. PHQ-9 and, where anxiety is prominent, GAD-7 are scored weekly during the acute course to track trajectory and inform the taper decision.

The final six sessions taper from five per week to three, then two, then one. Responders who later relapse — often 6 to 12 months post-treatment — are candidates for a second full course, and every major payer reimburses retreatment on documentation of prior response and current relapse (a PHQ-9 rise back into moderate-severe range with functional impact). For a subset of clients, a maintenance schedule of one session monthly or biweekly is negotiated with the payer.

What to expect at the first visit from Boca Raton

The consult is a 60- to 75-minute psychiatric evaluation in the Delray Beach office. The psychiatrist reviews the depression course, prior medication trials, current pharmacotherapy, comorbid diagnoses (anxiety, ADHD, substance use, bipolar spectrum), and any history of seizure or ferromagnetic cranial implants that would contraindicate stimulation. A cardiac pacemaker or vagus nerve stimulator is not a contraindication; a cochlear implant or deep brain stimulator is. Screening scales — PHQ-9, GAD-7, ASRS if attentional complaints are prominent, MDQ if bipolarity is on the differential, and YBOCS for OCD — are scored at intake.

If TMS therapy is appropriate, the psychiatrist submits the prior authorization the same day. Clients whose depression is embedded in an active substance-use pattern or an untreated bipolar spectrum are referred for stabilization first. rTMS in the context of untreated mania is contraindicated, and active alcohol use disorder requires medical stabilization — naltrexone or acamprosate, and CIWA-guided detox where indicated — before stimulation begins. Where esketamine or ketamine is a better-fit modality, that pathway is discussed at the same consult.

Insurance and admissions from Boca Raton

Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS are all in-network for rTMS at RECO Integrated Psychiatry. Out-of-pocket cost after authorization is limited to the plan’s specialist copay and any remaining deductible; there is no facility fee, because treatment is delivered in the outpatient office rather than in a hospital or PHP setting.

For Boca residents whose employer benefits sit with a national carrier — common along the I-95 tech and finance corridor — coverage of iTBS specifically is worth confirming at intake. RECO’s team runs the benefits check before the consult so the cost picture is clear before the first session, and admissions coordinates scheduling around a five-day-per-week course rather than expecting clients to solve the calendar themselves.

Serving residents of: Mizner Park, Royal Palm Place, Downtown Boca, Boca West, Highland Beach.