TMS therapy for Hollywood — outpatient TRD care, 50 minutes from home.

RECO Integrated Psychiatry runs a dedicated outpatient TMS suite in Delray Beach — a 50-minute drive up I-95 from Hollywood Beach, Emerald Hills, or Hollywood Lakes. The psychiatry team handles prior authorization for treatment-resistant depression coverage, motor threshold mapping at 120% MT, and both 10 Hz and iTBS protocols in-house, with no PHP enrollment and no facility fee. Hollywood clients typically standardize on a 7:00 a.m. appointment across the 30-session acute course and reverse-commute against the southbound morning traffic.

Hollywood sits 35 miles south of RECO Integrated Psychiatry’s Delray Beach office — 50 minutes on I-95 outside of rush hour, closer to an hour if the appointment lands inside the morning commute. For a six-week course of daily TMS, that distance is a scheduling problem worth planning around from the start. Most clients from Hollywood Beach, Emerald Hills, or Hollywood Hills book an early-morning slot that clears the office before southbound traffic thickens, then drive themselves home and continue their day. The TMS therapy program is delivered entirely in the outpatient office — no PHP enrollment, no IOP schedule, no facility fee.

Insurance-covered TRD candidacy and how we document it

Commercial insurance coverage for repetitive TMS in treatment-resistant depression is governed by payer-specific medical necessity criteria, and every major plan RECO Integrated Psychiatry contracts with requires the same core documentation. Two adequate antidepressant trials from different pharmacological classes, each at a therapeutic dose for six weeks or longer, with documented adherence. A course of evidence-based psychotherapy — most commonly CBT, sometimes ACT or interpersonal therapy where the treatment history supports it. And a current PHQ-9 placing the client in the moderate-to-severe or severe range.

Clients whose SSRI, SNRI, atypical antipsychotic, and augmentation trials are scattered across three or four prescribers rarely arrive with a clean summary in hand. Rebuilding that history — sertraline at 200 mg for eight weeks in 2022, aripiprazole augmentation at 5 mg discontinued for akathisia, a partial trial of lithium that never reached therapeutic level, a quetiapine trial abandoned for sedation — is part of the intake, not a barrier to it. The psychiatry team writes the letter of medical necessity in the format the specific payer requires and manages the prior authorization directly.

Denials are usually procedural — a missing dose-duration note, a psychotherapy trial the payer wants coded in a specific way — and are resolved through peer-to-peer review before the first mapping session is scheduled.

Motor threshold mapping and the first week

Session one is not treatment. It is motor threshold determination — the minimum single-pulse stimulator intensity that reliably evokes a visible right-thumb twitch (abductor pollicis brevis contraction) in five of ten trials. The coil is moved over the left motor cortex in small increments until the hotspot is identified, then intensity is titrated down to threshold. Treatment is delivered at 120% of that motor threshold, so the mapping number sets the dose for the entire course.

Treatment coordinates on the left dorsolateral prefrontal cortex are calculated from the motor hotspot using the Beam F3 method or a similar rule-based localization. Sessions two through five are acclimation. Scalp discomfort under the coil — a tapping sensation over the frontalis and superficial temporal branches — is most notable in the first week and typically fades as pericranial muscles habituate. Transient tension-type headache after early sessions is common and responds to acetaminophen.

Clients drive themselves to and from every session, return to work the same day, and require no sedation, no IV access, and no post-treatment monitoring beyond the appointment itself.

Standard 10 Hz versus intermittent theta burst (iTBS)

The FDA-cleared standard protocol is 10 Hz stimulation over the left DLPFC — 3,000 pulses per session, four-second trains, 26-second inter-train intervals, roughly 37 minutes of chair time. Intermittent theta burst stimulation delivers 600 pulses in a patterned burst sequence and completes in about three minutes. The THREE-D non-inferiority trial established iTBS as clinically equivalent to standard 10 Hz for major depressive disorder, and it is covered by most commercial payers on the same criteria.

The scheduling difference matters for Hollywood clients. A daily 45-minute appointment plus a 100-minute round-trip commute is a two-and-a-half-hour block; a three-minute iTBS session compresses that to a manageable morning stop. Not every commercial plan reimburses iTBS at the same rate as 10 Hz, and a small subset still requires a failed course of standard rTMS before authorizing iTBS. Coverage is confirmed in writing before mapping is scheduled.

Deep TMS on the BrainsWay H1 coil is available for treatment-resistant depression and, on the H7 coil, for obsessive-compulsive disorder with concurrent symptom provocation and YBOCS-tracked outcomes. Deep TMS uses a different coil geometry, a longer target, and a distinct authorization pathway.

Response, taper, and the retreatment question

Published response rates for rTMS in treatment-resistant depression are 40 to 60%; remission rates are 25 to 40%. PHQ-9 and, where warranted, MADRS are re-administered at baseline, session 10, session 20, and end-of-treatment. Response — defined as a 50% reduction from baseline PHQ-9 — typically emerges between sessions 15 and 25, sometimes earlier in clients who respond briskly and later in those who ultimately achieve remission over the full acute course.

The final six sessions are a taper, not additional acute treatment: three sessions in week seven, two in week eight, one in week nine. The taper is a durability strategy; observational data suggest it reduces early relapse relative to abrupt discontinuation. Maintenance protocols — weekly or monthly sessions — are considered case by case for clients with a history of frequent recurrence or partial response.

Responders who later relapse (most commonly 6 to 12 months post-treatment) are candidates for a second full course. Commercial payers generally cover retreatment on documentation of prior response, current relapse meeting the same PHQ-9 threshold, and re-verification of TRD criteria. Retreatment response rates in the literature approximate those of the initial course.

What the first visit looks like

The initial consult with a RECO Integrated Psychiatry attending runs 60 to 90 minutes. It is a structured psychiatric evaluation — DSM-5 differential, treatment history reconstruction, PHQ-9 and GAD-7 at intake, MDQ for bipolar screen and ASRS for adult ADHD where indicated, seizure-risk review, and a full medication reconciliation. Clients on bupropion, tramadol, clozapine, or other agents that lower seizure threshold are not disqualified but are documented and, in some cases, adjusted before mapping.

If the client meets TRD criteria and the evaluation supports rTMS as the appropriate next step, the psychiatrist writes the treatment plan and submits prior authorization the same day. Mapping is typically scheduled 5 to 10 business days later, once payer authorization is in hand. For Hollywood clients, the consult is usually the only visit requiring a mid-day appointment; every subsequent session can be booked at 7:00 or 7:30 a.m.

Insurance and the drive from Hollywood

RECO Integrated Psychiatry is in-network with the major Florida commercial plans Hollywood clients typically carry: Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS PPO plans. TMS is billed under CPT 90867 (initial with mapping), 90868 (subsequent), and 90869 (re-mapping); the professional and technical components are billed together as an office visit, with no separate facility fee.

The office is one block east of I-95 at the Atlantic Avenue interchange in Delray Beach. Clients coming from Hollywood Lakes, Oakwood, or Emerald Hills typically clear the drive in 50 to 60 minutes at 7:00 a.m. northbound and closer to 45 minutes on the return south. Sessions are booked in a standing weekday block so scheduling is set for the full 36-session acute course as soon as mapping is complete.

Serving residents of: Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, Oakwood.