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TMS stands for Transcranial Magnetic Stimulation therapy. It is a noninvasive form of brain stimulation where a magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil connected to the scalp. TMS is FDA approved for the treatment of depression. TMS uses a standardized “one size fits all” treatment protocol where the treatment location and magnetic stimulation frequency is the same for everyone. 

MeRT stands for Magnetic qEEG-guided Resonance Therapy. MeRT is a treatment that combines transcranial magnetic stimulation (TMS, an FDA cleared therapy), Quantitative Electroencephalogram (qEEG), and Electrocardiogram (ECG/EKG) to deliver treatments tailored for each individual’s unique brain pattern.

The patient’s qEEG and EKG are analyzed to determine the brain’s pattern of function and activity. The resulting information is used to develop a personalized treatment aimed at shifting brain connectivity to an individual’s ideal brainwave frequency, which can lead to significant clinical improvements.

Transcranial Magnetic Simulation (TMS) therapy delivers a standardized treatment approach that stimulates the same location of the brain at a fixed frequency for all patients. MeRT delivers an individualized treatment approach that varies in treatment location, treatment frequency, and stimulation intensity based on each patient’s quantitative EEG and EKG data.

Another difference is MeRT’s treatment intensity is lower than TMS. Less intense magnetic stimulation is needed to generate the same level of results due to MeRT’s use of individually tailored treatment location(s) and frequencies. Thus, less side effects are associated with MeRT compared to TMS.

For MeRT, we require a diagnosis for individuals seeking treatment for Autism Spectrum Disorder prior to starting therapy. For all other conditions, a diagnosis is not necessary to start MeRT.

For TMS, we require a diagnosis of Major Depressive Disorder without psychotic features prior to starting therapy.  For those seeking TMS insurance coverage, a Major Depressive Disorder diagnosis and multiple failed trials of anti-depressants is usually required to qualify for insurance coverage. 

Absolute contraindications for TMS and MeRT treatment at Mālama Manaʻo:

  • Pacemaker
  • Defibrillator
  • Vagal Nerve Stimulator
  • VP Shunt/ Magnetic intracranial shunts
  • Deep Brain Stimulator
  • Epidural Cortical stimulator
  • Steel shunts/stents
  • Cranial metal fragments (i.e. shrapnel, excluding titanium)
  • Schizophrenia or history of psychosis (i.e. hallucinations, delusions)
  • Cochlear implant
  • Aneurysm clips, coils, pipelines flow diversion
  • Pregnant or breastfeeding
  • Primary brain cancer/metastatic lesions in brain (unless palliative care)
  • Magnetic dental implants
  • Implanted cardio-verter defibrillators (ICD)
  • Ocular implants
  • History of seizure or seizure disorder within the last 10 years
  • *Bipolar Disorder Type I/II
  • *Schizophrenia or Schizoaffective Disorder
  • History of Psychosis (hallucinations, delusions)
  • *Active Suicidal Ideation

*May be treated at other TMS/MeRT centers, but not at Mālama Manaʻo

Relative contraindications (requiring closer protocol attention, but not disqualifying someone from receiving cortical TMS or MeRT treatment:):

  • History of Seizure or seizure disorder older than 10 years
  • Titanium shunts/stents
  • Spinal Cord Stimulator
  • Hearing aids
  • Ferrous cortical implants
  • Magnetic ink tattoo
  • Baha Implant
  • High Blood Pressure

Our clinician is able to diagnose patients. However for those who have never been formerly assessed by a mental health professional (psychologist, psychiatrist), we recommend formal assessment with Manakai O Malama’s behavior health team who offers diagnostic assessment and therapy for adults. Unfortunately, our clinician and the Manakai O Malama behavior health team cannot diagnose Autism Spectrum Disorder. 

Common benefits of TMS and MeRT include reduction of symptoms and behaviors interfering with daily functioning  and the following:

  • Better sleep
  • More relaxed; less anxiety
  • Mood improvement and increased emotional stability
  • Increased ability to adapt to change
  • Improved self-confidence, self-esteem, and sociability
  • More “presence” with Autistic patients (interaction and awareness with the world around them)
  • Better concentration and focus
  • Improved memory
  • Greater ability to cope with stress
  • Increased motivation
  • Decreased cravings for drugs and alcohol

Results are individual in nature, depending on the initial presenting symptoms, and are not guaranteed. 

Side effects are few, generally mild, and short-lived. The most commonly reported side effect is a mild tension headache, which typically responds well to over-the-counter painkillers. Other possible side effects are hyperactivity, fatigue, increased agitation, or euphoria. If side effects occur during treatment, inform your technician so that treatment may be adjusted accordingly.

With brain stimulation there is also a risk of seizures; however the risk is minimal for both TMS (1: 30,000) MeRT therapy (1: 100,000). At Mālama Manaʻo, MeRT treatment protocols take into account past or present seizure activity to reduce the risk of seizure caused by treatment.

MeRT is painless and non-invasive. MeRT stimulation is accompanied by a clicking noise and often feels like light to firm tapping in the stimulation area. If any discomfort is reported by a patient, our technicians are trained to adjust treatment intensity accordingly.

TMS stimulation is typically stronger and more intense than MeRT. It may feel like firm tapping and/or pressure in the stimulation area accompanied by a loud clicking noise. 

Every individual’s response to treatment is different. We require every new patient to undergo a 2 week assessment period. Generally, most people experience some sort of benefit within the first 2-3 weeks of treatment.

We recommend that you continue taking your prescribed medications while receiving TMS or MeRT and do not add, stop, or change any medications while receiving TMS or MeRT to ensure accurate progress monitoring. Please inform our clinician of all medications you are taking prior to starting treatment and let your technician know if any changes in medication occur during treatment.

For TMS, patients may choose to opt for additional treatment in the future. However, insurance coverage for additional TMS varies by insurance provider. Please check your insurance plan TMS policy for “retreatment”.

For MeRT, patients may choose to opt for additional treatment in the future if they wish to “refresh” benefits or pursue additional benefits. We recommend that patients take a 3 month break before pursing additional MeRT. 

For both TMS and MeRT, 6 weeks of continuous treatment is recommended.

Treatments are once per day, five days per week (Monday through Friday), at the same time every day. TMS sessions last 30 minutes while MeRT treatment session last approximately 30-45 minutes depending on your individualized protocol.

For MeRT, follow-up qEEG and a qEEG review with the clinician is scheduled near the end of each 2 weeks (10 MeRT treatments) to monitor your progress and inform continued care. 

For TMS, we recommend patients meet with our clinician near the end of each 2 weeks (10 TMS treatments) to monitor your progress. 

We highly recommend that you pursue other modalities of treatment for you or your loved one’s condition in addition to TMS or MeRT. Best practice for most health conditions is a multimodal approach as there are various components to treating different conditions (i.e. medical, psychological, educational, environmental, etc.).  Many past patients report that TMS MeRT increased their rate and level of benefits in other forms of treatment such as counseling, Applied Behavior Analysis, neurofeedback, etc. which increased their total level of clinical gains(s)

Our office is in the Gold Bond Building at 677 Ala Moana Blvd Honolulu, Hawaii 96813 within the Manakai O Malama office.

The Manakai O Mālama office is on the 9th floor Suite 950. We recommend patients to enter the parking garage from Coral St. and use the Ewa Wing elevators. 

You may park in the Gold Bond Building parking lot on Ala Moana Blvd at 677 Ala Moana Blvd. Honolulu, HI 96813. We recommend entering the parking garage from Coral St. and using the Ewa Wing elevators. Parking validation for a discounted rate ($1.75/hour) is available.

Financial FAQ

We are established with HMSA, UHA, Aetna, Cigna, Blue Cross Blue Shield, Tricare, and more. Consultation and qEEG evaluation fees for MeRT are billed to insurances accepted at Manakai O Malama. 

Transcranial Magnetic Stimulation (TMS) is FDA-cleared and covered by most major health insurances to treat those with multi-treatment resistant Major Depressive Disorder (MDD) in adults 18 years and older. Depending on your insurance, Magnetic qEEG-Guided Resonance Therapy may also be covered by insurance for the treatment of  multi-treatment resistant Major Depressive Disorder (MDD) in adults 18 years and older. To qualify and receive insurance coverage for TMS or MeRT under multi-treatment resistant Major Depressive Disorder (MDD), the following guidelines must be met (more specific guidelines may vary by insurance provider):  

1) A confirmed diagnosis of Major Depressive Disorder

2) Multiple failed trials of pharmacological intervention and a failed trial of psychotherapy with documentation

3) Order from a psychiatrist (MD or DO)

Treatment for all other conditions is considered “off-label” and is not covered by insurance. Any services not covered by your health insurance, including Medicare, are elective services that are to be paid “out of pocket”. Past patients were able to use Flexible Spending to pay for services. If you would like to file for reimbursement from your insurance or use your Flexible Spending, we can provide you an itemized receipt.

If insurance coverage is not available, out of pocket costs for baseline clinical intake and qEEG assessment services are listed below: 

~Baseline qEEG assessment: $200

~Clinician Consultation: $150

*For more information about cost of treatment, please call our patient coordinator. We are happy to work with you to figure out payment options, if insurance does not cover treatment for you.

Most insurances cover TMS for multi-treatment resistant Major Depressive Disorder (MDD) in adults 18 years and older. If you qualify under this condition, have your physician (preferably a psychiatrist) submit a referral with doctor’s notes documenting your diagnoses and treatments attempted to Manakai O Malama. We will then work on submitting a prior authorization to your insurance.

Referrals and notes may be sent to: 
Fax: 808-535-5550
Manakai O Malama Integrative Healthcare Group and Rehabilitation Center
Attention: Ira Zunin re: TMS 

For those seeking treatment for “off label” conditions, you may contact our patient coordinator at 808-754-1027 or to begin scheduling your initial consultation. MeRT consultations and qEEGs will be billed to insurances accepted at Manakai O Malama but treatment will need to be paid out of pocket. 

Thank you for your service! 

Tricare covers TMS and MeRT treatment for adults with multi-treatment resistant Major Depressive Disorder.  For both Tricare Prime and Tricare Select members, please have your primary care provider (PCP) submit a TMS referral to us with a physician signed TMS Letter of Attestation to expedite insurance prior authorization review. For Tricare Prime members, please also have your PCP submit a referral for “Evaluate and Treat Specialty Referral” for consultations and qEEGS to be covered by Tricare. Please contact us directly after you request a referral from your PCP, so that we may follow up on your referral. Once Tricare authorizes treatment, we will begin scheduling you for your first appointment.  

Referrals may be sent to: 
Fax: 808-535-5550
Manakai O Malama Integrative Healthcare Group and Rehabilitation Center
Attention: Ira Zunin re: TMS

Thank you for your service!

VA Healthcare offers coverage for TMS for multi-treatment resistant depression. Please schedule an appointment with your VA primary care, mental health provider, or neurologist and have them send a referral requesting Community Care treatment from Manakai O Malama if you have tried and failed other treatments for depression. 

Referrals may be sent to: 
Fax: 808-535-5550
Manakai O Malama Integrative Healthcare Group and Rehabilitation Center
Attention: Ira Zunin re: TMS

Please confirm with the VA that you are eligible and authorized for TMS therapy.  Once confirmed, please call us to notify us that you are seeking treatment. We will help follow up with the VA to ensure your referral arrives and verify all of the details needed in order for you to start treatment. 

Acceptable forms of payment are cash ($), check, and major credit cards including Visa, MasterCard, American Express, and Discover. There is a $25 processing fee for returned checks. If you have any questions or concerns regarding payment, please contact our patient coordinator. They are available at 808-754-1027 or