Transcranial Magnetic Stimulation (TMS) is a high-value, high-compliance treatment for depression. Payers scrutinize these claims, so perfect coding and ironclad prior authorization are non-negotiable for getting paid. Errors here are costly.
The TMS Billing Workflow
Prior Authorization (Mandatory):
- This is rule #1. You must document failed medication trials (typically 2-4) and a trial of psychotherapy.
CPT 90867 (Mapping):
- This is the initial motor threshold determination. It is billed once per course of treatment.
CPT 90868 (Treatment):
- This is the daily treatment code for repetitive TMS. Billed once per session.
CPT +90869 (Guidance):
- This is an add-on code for navigational (e.g., MRI-guided) guidance. Not all payers cover this.
Common Denials and Pitfalls
- No Prior Auth: The #1 reason for denial.
- Wrong Diagnosis: TMS is for Major Depressive Disorder (F32.x, F33.x). Billing for "anxiety" will be denied.
- Billing 90867 Daily: 90867 (Mapping) is a one-time code. Billing it with every 90868 is a major compliance violation.
TMS is Not Psychotherapy
"You cannot bill a psychotherapy code (like 90832) on the same day as 90868 unless a provider performs a full, separate, and documented therapy session. The 'check-in' with the TMS tech is bundled into the 90868."
