TMS therapy for Highland Beach — outpatient TRD care, 12 minutes from home.

RECO Integrated Psychiatry sits twelve minutes up A1A from Bel Lido Isle and Toscana — close enough to fold a six-to-nine-week rTMS course into a work schedule without commuting to Boca Raton or Fort Lauderdale for daily sessions. The clinic handles motor threshold mapping, prior authorization with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS, and in-house medication management across the treatment course. Deep TMS for OCD on the Brainsway H-coil and iTBS for clients with tighter schedules are both available on-site.

Highland Beach occupies a narrow three-mile ribbon between Delray Beach and Boca Raton, and the drive up A1A to RECO Integrated Psychiatry runs about twelve minutes from Bel Lido Isle, Toscana, or the condominium corridors of Boca Cove and Ocean Cove. That proximity is not incidental to the treatment. A course of transcranial magnetic stimulation for treatment-resistant depression requires daily attendance across six to nine weeks, and the clinical density RECO carries — motor threshold mapping, prior authorization management, in-house medication oversight — is not something a general behavioral-health office in coastal Boca is built to deliver.

Insurance-covered TRD candidacy and how we document it

Commercial reimbursement for repetitive TMS in major depressive disorder is gated by payer-specific definitions of treatment-resistant depression. Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans generally require documentation of two adequate antidepressant trials — adequate dose, adequate duration of typically six or more weeks each, and documented adherence — from at least two distinct pharmacologic classes, alongside a course of psychotherapy such as CBT or interpersonal therapy. Failed trials of sertraline, venlafaxine, bupropion, or an augmentation strategy with aripiprazole, quetiapine, or lithium are common on the intake sheet.

RECO’s psychiatry team reviews that history at the initial consult, requests prior records where needed, and reconstructs the trial timeline in the format the payer requires. For clients whose care has been scattered across multiple prescribers over years, that reconstruction is often the rate-limiting step in getting to the first treatment session. PHQ-9 scores at intake and during treatment are documented as well; most plans require a baseline in the moderate-to-severe range and periodic re-scoring across the course to substantiate medical necessity.

Motor threshold mapping and the first week

Session one is not treatment — it is motor threshold determination. The treating clinician identifies the minimum stimulator output that reliably evokes a right abductor pollicis brevis twitch through single-pulse stimulation over the left primary motor cortex, then translates that coordinate approximately five centimeters anteriorly along the parasagittal line to the treatment target over the left dorsolateral prefrontal cortex. Treatment intensity is set at 120% of motor threshold, and the standard FDA-cleared protocol delivers 3,000 pulses per session across a 10 Hz stimulation train.

Sessions two through five acclimate the client to the stimulation. Scalp discomfort at the treatment site is most notable in the first week and typically fades as accommodation develops; when it does not, minor lateral adjustments to coil position or a brief intensity ramp usually resolve it. Clients drive themselves in and out, return to work the same day, and do not require sedation, IV access, or post-treatment monitoring beyond the session itself. There is no cognitive fog and no dietary restriction — the constraints are the daily schedule and the drive.

Standard 10 Hz versus intermittent theta burst (iTBS)

The standard 10 Hz protocol runs 20 to 40 minutes on the treatment chair depending on device configuration. Intermittent theta burst stimulation is an FDA-cleared alternative that compresses equivalent-dose stimulation into a three-minute session with non-inferior efficacy demonstrated in the THREE-D trial and subsequent replications. For clients commuting from Highland Beach who cannot accommodate a daily 45-minute clinical window across six weeks, iTBS makes the course feasible where the traditional protocol may not.

Not every commercial plan reimburses iTBS at parity with the 10 Hz protocol, and some carriers require a specific CPT modifier or step-therapy attestation. RECO’s psychiatry team confirms coverage with the plan before scheduling and, where reimbursement diverges, walks the client through the practical trade-off. Deep TMS on the Brainsway H-coil platform is available for OCD candidates with YBOCS-documented moderate-to-severe symptoms on a separate FDA-cleared 18-session protocol.

Response, taper, and the retreatment question

Published response rates for rTMS in treatment-resistant depression fall in the 40 to 60 percent range; remission rates in the 25 to 40 percent range. Response typically emerges between sessions 15 and 25 — earlier in some clients, later in others — and PHQ-9 trajectory is monitored weekly to catch both response and non-response early enough to adjust. Non-responders at session 20 may be candidates for a protocol change, coil repositioning, or a switch to iTBS.

The final six sessions of the 36-session course are a structured taper — three per week, then two, then one — designed to consolidate response and reduce early relapse. Responders who later decompensate, typically at the 6-to-12-month mark, are candidates for a second full course; commercial insurance generally covers retreatment on documentation of prior response, current relapse, and a re-scored PHQ-9 in the qualifying range. Maintenance TMS on a monthly or bimonthly cadence is offered selectively for clients with a documented relapse pattern.

What to expect on your first visit from Highland Beach

The initial appointment is a 60-to-90-minute diagnostic and treatment-history consult with the psychiatrist. Expect a structured review of every prior antidepressant trial by dose, duration, and response; a psychotherapy history covering CBT, DBT, ACT, or EMDR exposures; screening for bipolar spectrum, personal or family seizure history, and ferromagnetic implants near the treatment field; and baseline PHQ-9 and GAD-7 administration. Where an ADHD or OCD contribution is suspected, the ASRS or YBOCS is added.

No stimulation is delivered at the first visit. If TMS candidacy is clear, prior authorization is initiated the same week, and motor threshold mapping is scheduled once the payer confirms — generally within one to three weeks. For clients arriving from Bel Lido Isle or Toscana, the office visit itself is a twelve-minute drive; the paperwork lift falls on the clinical team.

Coordinating TMS with medication management and psychotherapy

TMS is not delivered in a vacuum. Most clients continue an existing antidepressant regimen — sertraline, venlafaxine, bupropion, or escitalopram — across the course, and the treating psychiatrist manages the medication trajectory in parallel. Augmentation with aripiprazole or lithium is sometimes continued through the course and sometimes rationalized once response is durable. Buspirone or hydroxyzine for adjunct anxiety, and low-dose quetiapine for sleep architecture in the acute-response window, are used selectively.

Concurrent psychotherapy — CBT, ACT, or EMDR where trauma is a driver, motivational interviewing where ambivalence about treatment adherence is prominent — is coordinated in-network where possible or in referral where the client has an established therapist. For clients arriving with an active Spravato (esketamine) course elsewhere, the psychiatrist will reconcile the two arms; concurrent esketamine and rTMS is uncommon, case-dependent, and never delivered without a documented rationale.

Serving residents of: Bel Lido Isle, Boca Cove, Ocean Cove, Toscana, Penthouse.