TMS therapy for Jupiter — outpatient TRD care, 45 minutes from home.

RECO Integrated Psychiatry runs TMS as an outpatient psychiatric service 32 miles south of Jupiter on I-95 — 45 minutes from Abacoa, Tequesta, and Jonathan's Landing. For working clients, three-minute iTBS makes the standard six-week, 36-session course logistically feasible around a job and a family. Our psychiatrists handle the prior authorization, motor threshold mapping, and PHQ-9 tracking in-office — no PHP enrollment, no facility fee, same-day return to work.

The 32 miles between Jupiter and Delray Beach along I-95 translate to a 45-minute drive outside of rush hour — short enough to build into a daily TMS therapy schedule, long enough to keep the treatment separated from the routines that reinforce a depressive episode. RECO Integrated Psychiatry sees clients from Abacoa, Tequesta, Jonathan’s Landing, and Jupiter Inlet Colony for outpatient transcranial magnetic stimulation, and the format is deliberately compatible with an existing job, a school pickup schedule, and a family that lives at home. There is no PHP enrollment, no IOP schedule, and no facility fee.

Insurance-covered TRD candidacy and how we document it

Commercial coverage for repetitive transcranial magnetic stimulation is granted on a treatment-resistant depression indication, not a general major depressive disorder indication. Payers require documentation of two adequate antidepressant trials — meaning a therapeutic dose sustained for at least six weeks with reasonable adherence — plus at least one course of evidence-based psychotherapy such as CBT or interpersonal therapy. A trial of sertraline titrated only to 50 mg for three weeks is not adequate; a trial that was discontinued for tolerability at week two is not adequate. Our psychiatrists review the actual dose-duration history at consult and write the trials up in the language each payer’s utilization management team expects.

For clients whose care has been fragmented across a primary care physician, a therapist, and a prior psychiatrist, reconstructing the trial history is part of the intake. We request records from prior prescribers, cross-reference pharmacy fill data, and — where documentation is genuinely lost — attest to the clinical history under the payer’s affidavit process. Prior authorization for the initial 30 sessions is typically returned in 5-10 business days.

Motor threshold mapping and the first week

Session one is not a treatment session. It is motor threshold mapping — the minimum single-pulse stimulator intensity that produces a visible right-thumb twitch on 5 of 10 pulses over the left primary motor cortex. Once MT is established, treatment intensity is set at 120% of MT and the coil is repositioned approximately 5.5 cm anterior over the left dorsolateral prefrontal cortex. The 3,000-pulse standard 10 Hz protocol runs roughly 37 minutes; iTBS takes three.

Sessions two through five are acclimation. Scalp discomfort at the coil site is most notable in the first week and typically resolves as the local musculature adapts; ibuprofen 30 minutes pre-session helps if needed. There is no sedation, no IV line, and no cognitive impairment — clients drive themselves to and from the Delray office, return to work the same day, and don’t require a chaperone. A PHQ-9 is re-scored weekly and a GAD-7 is tracked in parallel where anxiety is a prominent feature.

Standard 10 Hz versus intermittent theta burst (iTBS)

The FDA-cleared standard protocol is 10 Hz stimulation delivered in 4-second trains with 26-second intertrain intervals — 3,000 pulses at 120% of motor threshold across roughly 37 minutes. Intermittent theta burst delivers 600 pulses in triplet bursts at 50 Hz, repeated at 5 Hz, in three minutes total. The THREE-D non-inferiority trial established equivalent response and remission rates between the two protocols for treatment-resistant depression.

For clients driving 45 minutes each way from Jupiter, a three-minute treatment session makes the six-week course logistically survivable in a way a 37-minute treatment session may not. Not every commercial plan reimburses iTBS at the same rate as standard 10 Hz, and a small subset still require the longer protocol. RECO’s TMS coordinator confirms the specific reimbursement code before the first session — the protocol decision is made once, not renegotiated mid-course. Deep TMS with the H1 or H7 coil is the platform used for the OCD indication and is scheduled and authorized separately using the YBOCS.

Response, taper, and the retreatment question

Published response rates for rTMS in TRD are 40-60%; remission rates run 25-40%. Response is not typically visible in the first two weeks. Between sessions 15 and 25 — roughly the start of week four — clinicians and clients begin to see PHQ-9 movement of five or more points, improved morning affect, and a return of interest in tasks that had gone flat. Non-responders at session 20 are reassessed; a coil-position adjustment, a shift to iTBS, or augmentation with aripiprazole or lithium is considered rather than declaring failure at the halfway mark.

The final six sessions are a formal taper: three per week, then two, then one. This structure appears to reduce short-term relapse compared with an abrupt stop. Responders who later relapse — the modal relapse window is 6-12 months post-course — are candidates for a second full course, and commercial payers typically cover retreatment on documentation of prior response and current relapse against DSM-5 criteria. Maintenance TMS on a monthly cadence is available for the subset of clients whose response was clear and whose relapse pattern is predictable.

What to expect on your first visit

The initial appointment in Delray Beach is a 60-minute psychiatric evaluation. The psychiatrist reviews the antidepressant trial history, screens for TMS contraindications (implanted ferromagnetic hardware above the neck, cochlear implants, active seizure disorder, unstable cardiac conditions), and rules out bipolar disorder using the MDQ and clinical interview. A PHQ-9, GAD-7, and — where OCD is on the differential — a YBOCS are administered. Where a substance use history is present, we use the ASAM Criteria dimensions to determine whether concurrent SUD care is warranted before TMS begins.

If TMS is clinically appropriate, prior authorization is initiated the same day. Motor threshold mapping is scheduled once authorization returns, and the first treatment follows immediately. Clients on medications that lower the seizure threshold — bupropion above 300 mg, clozapine, tramadol — are reviewed for dose adjustment or protocol modification before session one.

Insurance and admissions from Jupiter

RECO Integrated Psychiatry is in-network with Florida Blue, BCBS, Aetna, Cigna, UnitedHealthcare, and Humana across their commercial products. Medicare covers rTMS for TRD on the same treatment-resistant criteria as commercial payers, and Medicare is accepted for the TMS service line. Medicaid coverage of TMS in Florida is plan-specific and limited; the admissions team confirms benefits at intake rather than at the first treatment.

For Jupiter clients, out-of-pocket exposure is usually a specialist copay per session plus any unmet deductible. There is no facility fee — TMS at RECO is a professional outpatient service delivered in a psychiatric office, not a hospital-based procedure. The admissions coordinator provides a written benefits summary in advance so the total course cost is known before the first pulse is delivered.

Serving residents of: Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, Jonathan's Landing.