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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.

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. 

TMS therapy has shown a clinically significant response in around 50% to 80% of individuals with depression who did not experience beneficial results from medication therapy. About one-third of these individuals experience full remission, meaning that their depressive symptoms go away completely.

Based on our patient feedback, MeRT therapy has shown clinically significant response in up to 80% of individuals with depression; 66% of individuals with anxiety disorders; 70% of individuals autism; and 80% of individuals with TBI.

As with all depression treatments, TMS is not a cure. TMS benefits may last anywhere from a few months to 1 year after completing treatment. Insurance coverage for additional TMS varies by insurance provider. Please check your insurance plan TMS policy for “retreatment”.

Depending on the condition treated, MeRT benefits may last anywhere from a few months to years after completing treatment. 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 MeRT, 30 sessions over the course of 6 weeks is recommended. Treatments are once per day, five days per week (Monday through Friday), at the same time every day. MeRT treatment session last approximately 30-45 minutes depending on your individualized protocol. Follow-up qEEG recordings and a qEEG reviews with the clinician are scheduled near the end of each 2 weeks (10 MeRT treatments) to monitor your progress and inform continued care.

For TMS, 36 sessions over the course of 8 to 9 weeks is recommended. The first 6 weeks of treatment are once per day, five days per week (Monday through Friday), at the same time every day. The last 2 weeks of treatment are tapering sessions to wean patients off of TMS. Initial TMS sessions last 30 minutes. After initial sessions, TMS sessions last ~20 minutes. TMS patients meet with our clinician near the end of each 2 weeks (10 TMS treatments) to monitor your progress.

Every individual’s response to treatment is different. Generally, most people start experiencing benefits after 2-3 weeks of treatment.

For those being treated for depression, common signs of improvement include:

  • Sense of humor returns
  • Ability to manage and accomplish daily tasks that are important to life improve
  • Brighter and more hopeful mood
  • Feeling more present  
  • Start to enjoy activities and hobbies again or discover new things that bring joy
  • Increased energy and motivation in daily life

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, a diagnosis is not necessary. 

For TMS, a diagnosis of Major Depressive Disorder without psychotic features is needed prior to starting therapy. For those seeking insurance-covered TMS, insurances usually require a Severe Major Depressive Disorder diagnosis without psychotic features, 2+ failed trials of anti-depressants, and 1 failed trial of psychotherapy to qualify for coverage. We are able to provide assessment for Major Depressive Disorder, medication management, and refer for psychotherapy for those wishing to meet their insurance’s TMS criteria to qualify for TMS coverage. 

We treat adults and children ages 3 years and older. 

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
  • Recent history or active seizure(s) or seizure(s) disorder
  • Recent or active substance abuse
  • *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

Relative contraindications (requiring closer protocol attention, but not disqualifying someone from receiving cortical 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 provide assessment and diagnosis for depression, anxiety, and other mental health conditions.  We can also refer adult patients for psychological assessment with Manakai O Malama’s behavior health team.

Unfortunately, we are unable to assess and diagnose Autism Spectrum Disorder. 

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  TMS (0.1% per patient) MeRT therapy (0.00001 % per patient). 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. 

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

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 FDA-approved magnetic stimulator and coil is from MagVenture. 

Our office is in the Gold Bond Building at 677 Ala Moana Blvd Honolulu, Hawaii 96813, across from SALT in Kaka’ako. 

We are within the Manakai O Mālama office, 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, HMSA Quest, Blue Cross Blue Shield, Tricare, Aloha Care Medicare, Ohana Health Plan Medicare, United Healthcare, Medicare, workers’ compensation, and more. A referral to Manakai O Malama is required for all Quest and HMO plans for consultations and qEEGs to be billed to insurance. 

Transcranial Magnetic Stimulation (TMS), which MeRT employs, is FDA-cleared and covered by most major health insurances to treat those with multi-medication resistant Major Depressive Disorder (MDD) in adults 18 years and older. To qualify and receive insurance coverage, the following guidelines must be met (more specific guidelines may vary by insurance provider):  

1) A confirmed diagnosis of Moderate to Severe Major Depressive Disorder

2) 2+ failed anti-depressant trials and 1+ failed trial of psychotherapy 

3) Psychiatric evaluation and Order from a psychiatrist (MD, DO, Psych APRN) 

*If you are missing any of the above guidelines but believe you have depression and would like TMS/MeRT therapy, our clinician can work with you to complete the above guidelines to qualify for insurance coverage.

Treatment for all other conditions is considered “off-label” and requires payment out of pocket. Insurance reimbursement may be available for qEEGs and physician consultations depending on your health coverage. A referral is needed for those with HMO or Quest plans. Past patients were also able to use Flexible Spending to pay for TMS/MeRT. 

If insurance coverage is not available, out of pocket costs for baseline TMS and MeRT services are listed below: 

~Baseline MeRT qEEG assessment: $200

~TMS and MeRT Clinician Consultation: $150

~TMS or MeRT treatment: First 10 sessions $315 each. Additional sessions $250 each.

*We are happy to work with you to figure out payment options, including interest free payment plans, if insurance coverage is not available for you.

Most insurances cover TMS, some insurances also cover MERT, for treatment of multi-medication resistant Major Depressive Disorder (MDD) in adults under the following guidelines (more specific guidelines may vary by insurance provider):  

1) A confirmed diagnosis of severe Major Depressive Disorder

2) 2+ failed trials of pharmacological intervention and 1+ failed trial of psychotherapy 

3) Order from a psychiatrist (MD, DO, Psych APRN)

If you are seeking insurance covered TMS or MeRT for depression, have your psychiatrist or psych APRN submit a TMS referral with clinical notes to Manakai O Malama. 

Referrals may be sent to: 
Fax: 808-535-5556
Manakai O Malama Integrative Healthcare Group and Rehabilitation Center

*If you are missing any of the above insurance guidelines but believe you have depression and would like TMS/MeRT therapy, our clinician can work with you to complete your plan’s TMS guidelines to qualify for TMS insurance coverage. 

For those seeking treatment for other conditions, a referral is not needed.

Please contact our patient coordinator at 808-754-1027 or, if you have any questions. 

Thank you for your service! Tricare covers TMS and MeRT treatment for adults with multi-treatment resistant Major Depressive Disorder. 

For those with Tricare Prime, please have your primary care provider (PCP) submit referrals for TMS and “Specialty Evaluate and Treat” with a depression diagnosis to Manakai O Malama. Please also have your PCP or mental health physician (MD) sign and submit a TMS Letter of Attestation to Tricare to expedite insurance prior authorization review. 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.  

For Tricare Select or Reserve, a “Specialty Evaluate and Treat” referral is not necessary, but please have your PCP submit a TMS referral with a signed  TMS Letter of Attestation to Tricare to expedite insurance prior authorization review.

Information for PCPs to send Referrals to Tricare are below:

Fax: 808-535-5556
Haramandeep Singh MD  
Manakai O Malama Integrative Healthcare Group – Brain Wellness Center
677 Ala Moana Blvd #950 Honolulu, HI 96813 

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