GC Specialists Clinic

TMS Information - For Referrers

  • 1. What is rTMS and how does it work?

    Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive, outpatient neuromodulation procedure that uses focused magnetic pulses to stimulate targeted regions of the brain—such as the  dorsolateral prefrontal cortex (DLPFC), which is associated with mood regulation. A magnetic coil placed against the scalp delivers brief, repetitive pulses that pass painlessly through the skull to activate or modulate neural circuits implicated in depression.

    rTMS is entirely drug-free and does not require anaesthesia or sedation. Patients remain awake and alert throughout each session. There is no recovery period—patients can drive themselves to and from appointments and resume normal activities immediately after treatment.

  • 2. Which patients are suitable for rTMS?

    Under the current Medicare Benefits Schedule (MBS), the primary indication for rTMS is treatment-resistant Major Depressive Disorder (MDD) in adults aged 18 years and over. To qualify for Medicare-funded rTMS, patients must meet all of the following criteria:

    • A confirmed diagnosis of Major Depressive Disorder
    • An adequate trial of at least two different classes of antidepressant medication, each prescribed at a therapeutic dose for a minimum of 3 weeks (the RANZCP recommends 4–6 weeks for an adequate trial), unless contraindicated
    • Psychological therapy has been attempted (e.g. CBT, IPT, or equivalent evidence-based intervention), unless inappropriate
    • No prior course of repetitive rTMS treatment—whether Medicare-funded, privately funded, or delivered in a public hospital setting

    Beyond the Medicare-eligible pathway, rTMS may also be offered on a private/self-funded basis for conditions including generalised anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Suitability for these indications is assessed on a case-by-case basis during the initial psychiatric consultation.

  • 3. Is rTMS covered by Medicare?

    Yes. As of 1 November 2021, rTMS for treatment-resistant depression is listed on the Medicare Benefits Schedule under the following item numbers:

    • MBS 14216 — Prescription and treatment mapping for the initial course (performed by a psychiatrist with rTMS training)
    • MBS 14217 — Delivery of the initial treatment course (up to 35 sessions). May be performed by a trained health professional on behalf of the prescribing psychiatrist
    • MBS 14219 — Prescription and treatment mapping for a retreatment course (psychiatrist only)
    • MBS 14220 — Delivery of a retreatment course (up to 15 sessions)

    There is a lifetime cap of 50 Medicare-funded treatment sessions (35 initial + 15 retreatment). If the patient meets the Medicare eligibility criteria for rTMS, the treatment sessions are bulk-billed — meaning there is no out-of-pocket cost to the patients for the rTMS sessions themselves.  However, the initial consultation, motor threshold mapping & any subsequent reviews by a psychiatrist may attract additional gap payment. 

  • 4. What does a typical treatment course look like?

    A standard rTMS treatment pathway at GC Specialist Clinic involves the following stages:

    • Initial psychiatric assessment (approx. 1 hour): Comprehensive evaluation of diagnosis, treatment history, medication review, and screening for contraindications. If the patient meets eligibility criteria, a rTMS treatment plan is developed.
    • Motor threshold mapping: A brief session to calibrate the rTMS device to the individual patient’s brain physiology, establishing the correct stimulation intensity.
    • Treatment sessions: 20–35 sessions delivered over 4–6 weeks, typically once daily on weekdays (Monday to Friday). Each session lasts approximately 20–40 minutes depending on the protocol used.
    • Mid-course review: A clinical review with the psychiatrist at the approximate midpoint to assess progress and adjust the treatment plan if needed.
    • End-of-course review: A comprehensive assessment on completion of the treatment course, including outcome measures and discussion of ongoing management.
    • Post-treatment follow-up: A follow-up appointment approximately 4 weeks after the final session to evaluate sustained response and plan long-term care.

  • 5. How to refer a patient?

    A standard GP or specialist referral letter addressed to GC Specialist Clinic requesting a rTMS assessment is all that is required. To help us expedite the assessment process, you could include the following in your referral:

    • Confirmed diagnosis (MDD or other relevant condition)
    • Antidepressant medication history: names of medications trialled, doses, durations, and clinical response to each
    • Psychological therapy history (type, duration, outcome)
    • Relevant medical history, particularly: epilepsy or seizure history, cardiac pacemakers or implanted stimulators, metallic implants in or near the head, history of head injury or neurosurgery, cochlear implants

    Please send referrals to:

    GC Specialist Clinic

    Phone: (07) 5636 6666

    Email: info@gcspecialists.com.au

    Fax: (07) 5636 0905

  • 6. What are the contraindications?

    Absolute contraindications:

    • Ferromagnetic metallic implants in or near the head (excluding standard dental work such as fillings, crowns, and braces)
    • Cochlear implants
    • Implanted neurostimulators, deep brain stimulators, or cardiac pacemakers/defibrillators

    Relative contraindications (require careful risk–benefit assessment):

    • Personal history of epilepsy or seizures
    • Pregnancy or planned pregnancy
    • Raised intracranial pressure
    • Unstable medical conditions

    All patients undergo comprehensive safety screening during the initial psychiatric assessment. If you are uncertain about a patient’s suitability, we are happy to discuss the case with you prior to referral.

  • 7. What are the common side effects?

    rTMS is very well tolerated. Importantly, rTMS does not cause the systemic side effects associated with many psychotropic medications. There is no memory impairment, no weight gain, no sexual dysfunction, and no withdrawal symptoms.

    • The most commonly reported side effects are mild scalp discomfort or a tapping/tingling sensation at the treatment site during stimulation. Transient headaches are typically mild and most common during the first few sessions. They usually resolve spontaneously as patients habituate to treatment.
    • Very rarely one may experience facial twitching or feel faint (syncope)
    • The most serious potential adverse event is the induction of seizure. This is extremely rare, occurring in fewer than 0.01% of treatment sessions. Comprehensive safety protocols are in place at all times
    • The other rare, but potentially serious adverse effect is that of inducing a manic or hypomanic episode. These episodes can occur, most commonly in patients with a pre-existing diagnosis of bipolar affective disorder. In clinical experience they appear less common / quite rare in patients receiving mood stabilising medication whilst undertaking rTMS (The Royal Australian & New Zealand College of Psychiatrists)

  • 8. How does rTMS compare to ECT?

    rTMS and electroconvulsive therapy (ECT) are both effective neuromodulation treatments for depression, but they differ significantly in delivery and side-effect profile:

    • rTMS does not require general anaesthesia or sedation; ECT requires a general anaesthetic for each session
    • rTMS is delivered entirely on an outpatient basis with no recovery time—patients can drive themselves home and resume normal activities immediately
    • rTMS has no cognitive side effects; ECT is associated with short-term (and occasionally longer-term) memory impairment
    • rTMS sessions are generally well tolerated with minimal discomfort; ECT may involve post-procedure confusion, nausea, and muscle soreness

    ECT remains an important treatment option, particularly for severe, treatment-resistant, or life-threatening presentations where rapid clinical response is critical. For many patients with treatment-resistant depression, however, rTMS offers an effective alternative with a substantially more favourable side-effect and tolerability profile.

  • 9. What about patients who have had rTMS before?

    Once the patients have exhausted the lifetime cap of 50 sessions of rTMS, whether delivered through a public hospital or a private setting, and utilised the Medicare rebate, patients are not eligible for further Medicare funded rTMS. This is a firm Medicare eligibility requirement and applies regardless of when or where the prior treatment was delivered, or its clinical outcome.

    If you or the patient are unsure whether a prior claim has been made, eligibility can be verified using the Online Item Checker on the Services Australia website. Private/self-funded rTMS treatment may still be available for patients who have had prior rTMS and wish to pursue further treatment.

  • 10. What funding options are available?

    GC Specialist Clinic offers several funding pathways to support patient access to rTMS:

    • Medicare (bulk-billed): Eligible patients pay zero out-of-pocket for rTMS treatment sessions under MBS items 14216, 14217, 14219, and 14220.
    • Department of Veterans’ Affairs (DVA): Accepted for eligible veterans and serving personnel.
    • WorkCover Queensland: Accepted for approved claims.
    • Private health insurance: Selected private health funds may provide partial reimbursement—patients should check with their insurer.
    • Self-funded / private pay: Available for patients who do not meet Medicare criteria or who wish to pursue rTMS for non-Medicare-listed indications.

    Our team is happy to discuss funding options with patients during the initial assessment and can assist with the necessary paperwork for DVA and WorkCover claims.

  • 11. Questions or referral queries?

    For clinical queries, referral guidance, or to discuss a patient’s suitability for rTMS, please contact GC Specialist Clinic directly. We welcome the opportunity to work collaboratively with referring clinicians to optimise outcomes for shared patients.

    Phone: (07) 5636 6666  

    Email: info@gcspecialists.com.au

    Fax: (07) 5636 0905 

    Address: HQ@Robina, Suite 51, Level 5, 58 Riverwalk Avenue, Robina QLD 4226