Billing and Coding for TMS Therapy Explained

As Transcranial Magnetic Stimulation (TMS) therapy becomes a cornerstone of mental health treatment, understanding the intricacies of billing and coding is critical for practitioners, clinic owners, and billing specialists. Proper billing ensures compliance, streamlines reimbursement, and helps clinics thrive while providing life-changing care.

At Solstice Training Institute, we aim to demystify these processes and provide a clear roadmap to navigate TMS billing and coding successfully.

The Basics of TMS Billing and Coding

Billing for TMS therapy is distinct because it involves both procedural codes and device-specific considerations. To ensure proper reimbursement, accurate use of Current Procedural Terminology (CPT) codes is essential.

• Evaluation Codes: The initial assessment for TMS therapy typically uses CPT codes related to psychiatric consultations (e.g., 90792). A more thorough evaluation may command a higher level E/M code such as 99204, but this depends on length or complexity (especially if an add-on psychotherapy code is used, such as 90833).

• Treatment Codes: TMS-specific codes include: 

• 90867: Initial motor threshold determination, including delivery of the first treatment. This is always done on the first treatment, and involves finding the “motor threshold,” calibrating the machine to the patient’s correct level of stimulation between 80-120% of their motor threshold, and then administering the first session.

• 90868: All subsequent TMS treatments.

• 90869: Re-determination of motor threshold. This is typically done once or twice throughout a series of TMS.

Each of these codes requires careful documentation to reflect the service rendered. Most of the time, prior authorization is required in order to render any of these codes. Lately, insurance companies such as Anthem Blue Cross require a concurrent authorization request in order to bill for 90869 specifically.

Notable Documentation Requirements

Accurate documentation is required for insurance claims to process correctly. Without it, claims may get denied, providers can get put on pre-payment reviews or be at increased risk for audits. Some components include:

• Detailed Patient Records, including diagnosis, rationale for the medical necessity for TMS, and comprehensive treatment history.

• Motor Threshold Information: Document the motor threshold determination procedure.

• Daily Progress Notes: Maintain records of each and every session, including patient response and any modifications to the treatment plan. Make sure that the diagnosis, relevant CPT code, date of service, technician name, rendering provider, and place of service are clearly demarcated in the note itself.

Insurance Authorization for TMS Therapy

Most insurance providers require pre-authorization for TMS therapy. This process involves submitting clinical documentation proving the patient meets the criteria, such as:

1. A confirmed diagnosis of treatment-resistant depression or another approved condition.

2. Detailed faliure of prior medication and therapy trials.

3. Supporting evidence from psychiatric evaluations.

4. Lack of medical contraindications such as seizure disorders or intracranial pressure.

5. Lack of device contraindications such as pacemakers, cardioverter defibrillators, or ferromagnetic stents.

Common Challenges in TMS Billing

While TMS billing can be straightforward with proper training, some common pitfalls include:

• Coding Errors: Using the wrong CPT code can result in denied claims or underpayments.

• Incomplete Documentation: Missing details in progress notes or evaluations can jeopardize reimbursement.

• Lack of Insurance Familiarity: Different payers have varying policies for TMS therapy, requiring thorough research and consistent updates.

Tips for Efficient TMS Billing

1. Stay Updated: CPT codes and insurance policies for TMS evolve. Regular training and resources, like those offered by Solstice Training Institute, keep your knowledge current.

2. Invest in Billing Software: Dedicated platforms for mental health billing can automate and streamline your processes.

3. Train Your Team: Ensure staff understands the nuances of TMS billing and coding. Our business course at has a detailed billing lesson which will provide you or your team anything you need to know in order to get paid for TMS.

How Solstice Training Institute Can Help

At Solstice Training Institute, A Public Benefit Corporation, we offer specialized courses in TMS administration and billing. Our program is designed to provide:

• A comprehensive understanding of CPT codes and insurance requirements.

• Step-by-step guidance for submitting claims and managing denials.

• Expert tips for maximizing reimbursement rates.

• Best practices

By equipping your team with the knowledge and tools to master billing, you can focus on what matters most: delivering transformative care to your patients.

Ready to enhance your TMS practice?
Visit Solstice Training Institute, A Public Benefit Corporation to learn more about our comprehensive training programs on billing and coding for TMS therapy.