TMS therapy for Lantana — outpatient TRD care, 18 minutes from home.

RECO Integrated Psychiatry runs its TMS program out of Delray Beach — 11 miles and 18 minutes south of Lantana down Federal Highway. The psychiatry team handles motor threshold mapping, prior authorization documentation for Florida Blue, Aetna, Cigna, UnitedHealthcare, and Humana, and the full 36-session FDA-cleared protocol without PHP enrollment or facility fees. For Hypoluxo Island, Manalapan, and Ocean Ridge residents, it is the closest specialist-led outpatient TMS practice north of the Broward County line.

Lantana sits on a slender stretch of Palm Beach County coast — Hypoluxo Island, Manalapan, Ocean Ridge, and the historic core of Old Town Lantana all within a few blocks of the Intracoastal. From these barrier-island neighborhoods, RECO Integrated Psychiatry’s Delray Beach office is 11 miles south, roughly 18 minutes down Federal Highway and less along A1A on a quiet morning. For adults in Lantana who have exhausted two or more antidepressant trials without adequate response, our TMS therapy program is the closest FDA-cleared, outpatient rTMS service north of the Broward County line.

Insurance-covered TRD candidacy and how we document it

Commercial coverage for repetitive TMS in treatment-resistant major depressive disorder is gated on a specific documentation standard. Florida Blue, Aetna, Cigna, UnitedHealthcare, and Humana each require evidence of at least two adequate antidepressant trials — adequate dose at or above the therapeutic minimum, adequate duration of six weeks or longer per agent, and documented adherence — typically drawn from two different pharmacologic classes. A course of evidence-based psychotherapy, most often cognitive behavioral therapy (CBT), is also required in the utilization review checklist.

At the consult, RECO’s psychiatry team walks through the treatment history in the payer-required format. A representative history might include sertraline titrated to 200 mg, an augmentation trial with aripiprazole at 5 mg, a switch to venlafaxine XR at 225 mg, and a subsequent lithium adjunct at a level of 0.6 mEq/L — the reconstruction has to specify start and stop dates, response captured with PHQ-9 scores where available, and reason for discontinuation. Precise documentation is the difference between a same-week prior authorization and a denial that adds three weeks to the timeline.

For clients whose care has been scattered across multiple prescribers — a Delray Beach primary care doctor, a psychiatrist in Boca, a therapist in West Palm — the intake includes records reconstruction. RECO pulls prior notes, verifies fills through the state PDMP where relevant, and assembles the trial history that the payer’s utilization reviewer actually reads.

Motor threshold mapping and the first week

The first billable TMS session is not treatment but calibration. Motor threshold determination establishes the lowest stimulator output that reliably produces a contralateral thumb twitch when the coil is positioned over the primary motor cortex. That value — expressed as a percentage of the machine’s maximum output — anchors the treatment intensity, set at 120% of motor threshold over the left dorsolateral prefrontal cortex per the FDA-cleared protocol.

Sessions two through five are acclimation. The 10 Hz train delivers 3,000 pulses over 20 to 40 minutes, and scalp discomfort at the coil site is most pronounced during the first week before local sensory nerves habituate. Roughly one client in twenty experiences tension-type headache that responds to acetaminophen. Seizure risk on standard protocol is under 0.1% per course, with the majority of cases occurring in clients with unreported seizure history or concurrent proconvulsant medications such as bupropion at doses above 450 mg.

Clients drive themselves to and from Lantana daily. There is no sedation, no post-session monitoring, no restriction on returning to work or operating machinery. The stimulation is focal — motor and sensory function outside the treatment field are unaffected — and the client can leave the office and go directly to a meeting.

Standard 10 Hz versus intermittent theta burst (iTBS)

Standard 10 Hz repetitive TMS runs 20 to 40 minutes of active stimulation per session, five days a week for six weeks, followed by a three-week taper. Intermittent theta burst stimulation (iTBS) is an FDA-cleared alternative that compresses the same therapeutic dose into a three-minute session. The pivotal THREE-D trial demonstrated non-inferiority to 10 Hz for major depressive disorder.

For a Lantana resident whose workday cannot accommodate a 45-minute midday appointment plus travel, iTBS makes the six-week course logistically feasible. The trade-off is coverage variability: not every commercial plan reimburses iTBS at parity with standard 10 Hz, and some require step therapy — a documented failure of the longer protocol first. RECO’s team confirms coverage in writing before scheduling to prevent mid-course surprises.

For OCD, the deep TMS H7 coil protocol is a separate FDA clearance requiring provocation-based symptom activation before each session and YBOCS-guided response tracking. Deep TMS for OCD runs 29 sessions over six weeks and requires a distinct prior authorization pathway.

Response, taper, and the retreatment question

Published response rates for rTMS in treatment-resistant major depression cluster between 40 and 60%, with remission — a PHQ-9 below 5 or a Hamilton depression score below 8 — in 25 to 40% of completers. Response typically emerges between sessions 15 and 25, though a subset of clients respond earlier and a smaller subset only in the final week. Non-response by session 25 is a signal to reassess with the psychiatrist, not automatically to discontinue; augmentation with esketamine, a switch to iTBS, or a coil-position audit are options at that decision point.

The final six sessions of the standard protocol are a structured taper: three per week for two weeks, then two, then one. The taper is clinically meaningful. Abrupt termination at session 30 correlates with earlier relapse; the graduated withdrawal appears to consolidate response and is what the FDA-cleared protocol prescribes.

Relapse in TRD after successful rTMS is common — roughly 30 to 40% of responders relapse within twelve months, with the median relapse falling between 6 and 12 months post-treatment. Insurance typically covers a full retreatment course on documentation of prior response, a currently active depressive episode meeting MDD criteria, and PHQ-9 above the retreatment threshold. Some clients do better with scheduled monthly maintenance sessions; others prefer retreatment on relapse.

What to expect on your first visit

The initial consult is 60 to 75 minutes with the psychiatrist. The interview covers depressive history in DSM-5 terms, treatment history in the payer-required format, medical comorbidities relevant to TMS candidacy — implanted ferromagnetic devices near the coil site, prior seizure, active pregnancy — and the differential. Bipolar depression, unipolar TRD, and unipolar depression with mixed features have different management pathways, and the distinction shapes whether TMS is appropriate as monotherapy or adjunctive to mood stabilizer optimization with lithium or quetiapine.

Standardized measures at intake include the PHQ-9 for depression, GAD-7 for anxiety, and the MDQ or a structured mood-episode timeline to screen for bipolar spectrum. For clients with prominent OCD features the YBOCS is administered. Adult ADHD screening with the ASRS is common in this population — untreated inattentive-type ADHD is a frequent confound in apparent antidepressant non-response and warrants management with a stimulant or atomoxetine before or alongside TMS.

Insurance and admissions from Lantana

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and most BCBS plans for outpatient psychiatry and TMS. The admissions team verifies benefits before the consult and provides a written estimate of per-session coinsurance and deductible responsibility. TMS-specific benefits — session cap, iTBS parity, retreatment allowance — are confirmed in writing with the payer before scheduling.

For Lantana residents, the drive to the Delray Beach office is 11 miles down Federal Highway or A1A depending on Intracoastal traffic. Same-day return to work is the norm. For clients whose employers require documentation, RECO provides FMLA and short-term disability paperwork; the six-week course typically does not require full leave, but reduced-hour accommodations are supported where clinically indicated.

Serving residents of: Hypoluxo Island, Manalapan, Ocean Ridge, Old Town Lantana.