For referring providers

Interventional psychiatry referrals: TMS and Spravato

Cognifica Health offers TMS therapy and Spravato (esketamine) as the next clinical step for patients who have not achieved adequate response with standard antidepressant treatment. Workers compensation approved. Two locations across Long Island and Westchester.

Call to discuss a referral →Long Island: (631) 388 7624

Multidisciplinary teamNeurology, psychiatry & care coordination
Insurance acceptedMedicare, Tricare, most major plans
Virtual visitsTelehealth for qualifying services
2 locationsLong Island and Westchester, NY
500+ patientsTrusted by families since 2018

When to refer

TMS referral criteria

Major Depressive Disorder with inadequate response to two or more antidepressant trials (adequate dose and duration)
OCD with inadequate response to first-line treatment — TMS cleared as adjunct
Anxious depression (MDD with comorbid anxiety symptoms)
Patients who cannot tolerate antidepressant side effects — TMS is a non-medication alternative, not only a last resort after medication failure
Adolescents aged 15 to 21 with treatment-resistant depression (FDA cleared 2024, adjunct treatment)
Workers compensation patients with documented depression — TMS is approved for these patients at Cognifica Health
Patients seeking non-pharmacologic treatment

Spravato referral criteria

Treatment-Resistant Depression (TRD): inadequate response to two or more antidepressants of different classes at adequate doses for adequate duration
MDD with acute suicidal ideation or behavior requiring rapid reduction of depressive symptoms
Patients who cannot tolerate or have contraindications to oral antidepressants — 2025 monotherapy approval allows Spravato without a concurrent antidepressant
Patients who have previously responded to ketamine infusions and prefer an FDA approved and insurance-covered alternative
High-acuity cases where speed of response is clinically important — improvement documented as early as 24 hours post-dose

TMS clinical summary

TMS uses brief magnetic pulses comparable in strength to MRI fields to stimulate targeted cortical regions. The following summarizes the evidence base and protocol as used at Cognifica Health.

Evidence base

Real-world response rate: 58–78% (significant symptom reduction)
Real-world remission rate: 30–37%
Durability: Approximately 68% of responders maintain improvement at 12 months post-treatment
Seizure risk: <0.1% — comparable to antidepressant medication risk
Primary data source: PMC11234753 — multi-site psychiatric group practice registry

Protocol and FDA status

FDA status: Cleared — MDD (adults 2008, adolescents 15-21 adjunct 2024), OCD adjunct, anxious depression
Session length: 20 to 40 minutes
Treatment course: 5 sessions per week for 4 to 6 weeks (30–36 sessions total)
Anesthesia required: No — patients remain fully alert and can drive
Medication interactions: None — TMS can be used concurrently with current medications
Contraindications: Non-removable conductive metal in or near the head; prior seizure history requires evaluation

Workers comp approved

Workers compensation has already approved TMS for Cognifica Health patients. Relevant for occupational medicine physicians, pain management providers, and case managers where depression is a secondary documented condition.

Two active TMS sites

TMS is available at both our Aquebogue (Long Island) and West Harrison (Westchester) locations. Geographic coverage for referrals across both service areas.

All three FDA-cleared indications

Cognifica Health treats patients under all three TMS clearances: Major Depressive Disorder, OCD (adjunct), and anxious depression. The 2024 adolescent clearance (ages 15 to 21) is also available.

Non-medication candidate pathway

TMS is appropriate not only for patients who have failed medications, but for patients who cannot tolerate medication side effects — an underserved and often overlooked referral category.

Spravato clinical summary

Spravato (esketamine) is an NMDA receptor antagonist — pharmacologically distinct from monoaminergic antidepressants. The following summarizes the evidence base, FDA status, and administrative requirements.

FDA approval history

March 2019: TRD in conjunction with oral antidepressant (NDA 211243)
August 2020: MDD with acute suicidal ideation or behavior — in conjunction with oral antidepressant
January 2025: TRD as monotherapy — first FDA approved antidepressant monotherapy of its mechanism class

Clinical data and REMS

Onset of action: Measurable improvement in MADRS total score as early as 24 hours post-dose
Monotherapy remission (week 4): 22.5% vs. 7.6% placebo (NCT04599855)
Relapse prevention: SUSTAIN-1: significantly delayed relapse in responders vs. placebo
REMS requirement: Certified healthcare setting only; 2-hour post-dose observation mandatory
Administration: Patient self-administers under direct provider supervision; prescriber must be licensed APRN, PA, or physician
Common adverse effects: Dissociation, dizziness, nausea, sedation, hypertension — typically resolve within the observation period

REMS certified treatment site

Cognifica Health is a REMS certified Spravato treatment site — a federal requirement for any practice administering esketamine. Not all psychiatric practices qualify.

2025 monotherapy approval

The January 2025 FDA approval allows Spravato to be used without a concurrent oral antidepressant. Patients who have failed or cannot tolerate oral antidepressants now have a monotherapy pathway.

Rapid onset for high-acuity cases

Clinical data show measurable improvement in depressive symptoms as early as 24 hours after the first dose. Spravato is also approved for MDD with acute suicidal ideation or behavior, making it relevant for patients requiring rapid clinical response.

Supervised in-office administration

All Spravato sessions are supervised by Susan Mogan, PMHNP, under the oversight of Dr. John Abrahams, MD. Patients remain on-site for a minimum of two hours per session.

Workers compensation pathway

TMS approved for workers comp patients at Cognifica Health

Workers compensation has already approved TMS for patients at Cognifica Health. This is a meaningful clinical pathway for occupational medicine physicians, pain management providers, and workers compensation case managers.

Depression as a secondary condition following workplace injury is well documented in the literature and is routinely underdiagnosed and undertreated in workers comp populations. TMS offers an evidence-based, non-medication intervention that workers comp carriers have recognized as appropriate treatment.

B2B referral targets

Provider categories that have referred successfully to Cognifica Health for TMS and Spravato:

→Primary care physicians
→Occupational medicine physicians
→Pain management specialists
→Neurologists
→Psychologists (non-prescribing)
→Licensed clinical social workers
→Workers compensation case managers
→Substance use treatment programs

Referral process

Contact our office

Call (914) 948 3008 (Westchester) or (631) 388 7624 (Long Island) to discuss a referral. Our clinical coordinator will confirm candidacy criteria and insurance before the patient is scheduled.

Send referral packet

Include: diagnosis, prior medication trials with doses and durations, relevant medical history, current medication list, and any prior neuropsychological testing. Fax or coordinate directly with our office.

Patient intake

Your patient completes a one-hour intake with Susan Mogan, PMHNP. No pre-screening call is required. Intake can be in-person or via telehealth.

Communication back to you

With patient authorization, we send clinical updates at intake, treatment initiation, and course completion. We are available for consultation throughout the treatment period.

Insurance accepted

Confirmed in-network

Medicare
Workers compensation
No-fault insurance
United Healthcare

Pending enrollment

Blue Cross Blue Shield, Aetna, Cigna, Health First, Fidelis, Medicaid, UMR, World Trade Center benefit fund

Out-of-network patients can receive a super bill. TMS and Spravato are HSA and FSA eligible expenses.

Contact for clinical questions

Dr. John Abrahams, MD and Susan Mogan, PMHNP

For clinical questions about a specific patient, call our office directly. We are available for provider-to-provider consultation.

Westchester: (914) 948 3008
Long Island: (631) 388 7624

Submit a referral →

Start a referral

Send us a referral inquiry

Fill in your contact details and what you are referring for. Our clinical coordinator will follow up within one business day to confirm candidacy and next steps. No patient information is collected here.

Prefer to call?

Westchester: (914) 948 3008
Long Island: (631) 388 7624

Provider-to-provider consultations available by phone.

Provider questions

Call our office directly at (914) 948 3008 (Westchester) or (631) 388 7624 (Long Island) to discuss a referral. A referral packet should include prior treatment history, relevant medication trials with doses and durations, current diagnosis, and any relevant medical history. We will contact your patient within one business day to schedule an intake.

Sources and References

Share with your patient

For patients →

Insurance, what to expect, side-by-side TMS vs Spravato comparison

For families and caregivers →

Transport requirements, what to expect on treatment days, privacy information