Practice owners ask me this question constantly, usually right after a vendor pitch: should we add TMS or SPRAVATO first? I have established both in my own practice, and I can tell you there is no universal answer.
There is, however, a right answer for your balance sheet, your building, and your patient panel. Here is the framework I wish someone had handed me.
The capital picture
With TMS, the money is in the machine — purchase or lease, plus service contracts and supplies. It is a capital decision. With SPRAVATO, the equipment burden is minimal, but you are sourcing medication through REMS-certified pharmacy channels and dedicating room-hours to monitored sessions. That is a capacity decision. Know which kind of decision you are actually making before you compare the two.
Space and staffing
TMS needs a dedicated treatment room and a trained technician delivering daily sessions — patients typically come five days a week over about six weeks, then taper. SPRAVATO needs a comfortable monitoring space where patients remain for at least two hours per session, with clinical staff observing and a prescriber overseeing care. Both are staffing models before they are anything else.
Patient flow and adherence
TMS asks patients to show up daily — powerful for engagement, genuinely hard for patients with jobs and long drives. SPRAVATO sessions are far less frequent but long, and patients cannot drive themselves home afterward on treatment days. Look at your actual panel and your local geography: which pattern can your patients realistically complete? A service patients abandon mid-course helps no one.
The payer work
Both services are criteria-driven and documentation-heavy. TMS leans on prior-authorization volume and documented treatment history. SPRAVATO adds REMS compliance on top of buy-and-bill or specialty-pharmacy workflows. Either way, your documentation system is the product — if it is weak, reimbursement will be too.
Five questions to decide
- Do I have capital for equipment, or room-hours to spare — which is scarcer?
- Can my staffing cover daily short treatments, or long monitoring windows — which fits the team I have?
- What does my referral base actually send me?
- Which payer contracts do I already hold, and what do they require?
- Can I run one service excellently before I add the second?
Most practices should start with the service their operations can run flawlessly, build the referral and documentation engine around it, and then expand. Starting both at once is how owners end up — as I did — paying tuition in mistakes. Sequenced correctly, either service can become a strong second pillar for a psychiatric practice.
Deciding between TMS and SPRAVATO — or planning to add both? See how our TMS & SPRAVATO Startup & Implementation Consulting works or book a TMS & SPRAVATO Strategy Call.
Educational business information only—not medical, legal or financial advice. Review clinical, privacy, communications and financial decisions with appropriately qualified professionals.