Everything you need to know about TMS CPT Codes 90867, 90868 and 90869 Explained — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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CPT 90867 is the first TMS session of a course: it includes finding your treatment spot (cortical mapping), measuring your motor threshold, and delivering the treatment. CPT 90868 is every regular session after that. CPT 90869 is a later session where your motor threshold is measured again before treatment. Your clinic bills one of the three for each visit.
If you’re looking at an insurance statement, a prior authorization letter or a clinic estimate and trying to work out what those five-digit numbers mean, this guide walks through them.
Key takeaways
- 90867 is the initial session: mapping, motor threshold and treatment. It is billed once at the start of a course.
- 90868 is a subsequent treatment session. Most of the visits in your course will carry this code.
- 90869 is a subsequent session that includes re-determining your motor threshold. You’ll see it on days your clinic re-checks the dose, not on every visit.
- A manufacturer coding guide says the three codes are not reported together for the same session, so one visit should produce one TMS line on your statement.
- Coverage decisions are made by your plan, not by the code. A code tells you what was done; it doesn’t tell you whether your plan will pay.
The three codes in plain English
These three codes are part of the CPT code set, which is owned and published by the American Medical Association. The wording below follows the descriptors as quoted in a Blue Cross Blue Shield of Michigan Medicare Advantage policy, which reproduces them.
| Code | Descriptor (shortened) | What it means for you |
|---|---|---|
| 90867 | Therapeutic repetitive TMS treatment; initial, including cortical mapping, motor threshold determination, delivery and management | Your first session. The clinician finds where to place the coil, measures how much magnetic energy it takes to make your hand twitch, then treats. |
| 90868 | Therapeutic repetitive TMS treatment; subsequent delivery and management, per session | A regular treatment day. No new threshold measurement. |
| 90869 | Therapeutic repetitive TMS; subsequent motor threshold re-determination with delivery and management | A treatment day that starts with a fresh motor threshold measurement. |
A few third-party billing sites reverse the descriptions of 90868 and 90869. If you see one saying 90869 means “no new threshold determination,” it has them backwards. The AMA wording ties 90869 to the threshold re-determination.
What the motor threshold has to do with billing
Your motor threshold is the lowest stimulation intensity that produces a small, involuntary thumb or finger movement when the coil sits over the motor cortex. Clinics use it to set your treatment dose, so it matters for how well the course works. Our guide to understanding TMS motor threshold explains the measurement in detail.
Because the threshold is part of the dose, it makes sense that clinics sometimes measure it again. It can drift over a course, and a clinic may re-check it if your response isn’t what they expect, if you’ve had a medication change, or if something about the setup has changed. That re-check is what separates a 90869 day from a 90868 day.
Aetna’s clinical policy bulletin on TMS, for example, says one remapping per course is considered medically necessary, and that more than one may be justified if the patient isn’t responding or the motor threshold may have changed. That’s one insurer’s wording; other plans word it differently or say nothing. Aetna’s policy is here.
What a typical course looks like on paper
Courses vary by device, protocol and clinic, but the billing pattern usually looks like this:
- Day one: one unit of 90867.
- Most days after that: 90868, once per session.
- A handful of days: 90869 in place of 90868, on days when the threshold is re-measured.
There is no fixed number of 90869 visits. It depends on what your clinician decides is needed and what your plan allows. If you want to know how many sessions a plan will typically approve, we cover that in a separate post on how many TMS sessions insurance covers.
How the codes can and can’t be combined
A hospital outpatient coding guide from NeuroStar’s manufacturer says not to report 90867 together with 90868 or 90869, and not to report 90869 together with 90867 or 90868. It is a manufacturer’s reference from 2017, not a payer rule, so treat it as a guide to the logic: one visit, one TMS code. You can read the NeuroStar hospital coding reference guide if you want the detail.
The same guide notes that a separate evaluation and management (E/M) visit by the same physician on the same day may sometimes be reported in addition to TMS when the E/M service is significant and separately identifiable. In practice, that means a day when you see the psychiatrist for a medication review and then get a session might produce two lines on your statement. That’s not automatically an error, but it’s fair to ask the billing office what each line is for.
Other codes you might run into
- Psychiatric evaluation codes. The visit where you’re assessed for TMS is billed separately from the treatment codes.
- Category III codes. The same Blue Cross Michigan policy lists 0858T, 0997T and 0998T, which describe newer techniques (for example, treatment planning guided by MRI and EEG for precuneus stimulation). Category III codes are temporary codes for emerging technology. A plan can treat them very differently from 90867 to 90869, so if your clinic offers one of these, ask whether your plan covers it before you start.
- Diagnosis codes. Plans pair the TMS codes with a diagnosis, nearly always major depressive disorder, which is what the FDA clearance covers.
Why codes show up in prior authorization
When your clinic asks your plan for approval, it lists the codes it expects to bill. Humana’s commercial preauthorization and notification list (the revision we reviewed is dated December 2024) lists 90867, 90868 and 90869 together under behavioral health services. You can see it in Humana’s published list. Lists change, so check the current version for your plan.
The practical point: ask your clinic which codes are on your authorization request. If it names 90867 and 90868 but your clinic expects to re-check your threshold, ask whether 90869 is covered by the same approval. It’s a two-minute call that can save a surprise. Our guide to how prior authorization works for TMS covers the process step by step.
Medicare uses the same codes
Original Medicare coverage for TMS is set by regional Medicare contractors through local coverage determinations (LCDs), and the same three CPT codes are used. According to the Blue Cross Michigan policy above, the LCDs by contractor include:
| Medicare contractor | LCD |
|---|---|
| WPS | L34641 |
| CGS | L36469 |
| First Coast | L34522 |
| Noridian (JE and JF) | L37086 |
| Novitas | L34998 |
| Palmetto | L34869 |
| Wellpoint Federal | L33398 |
Which one applies depends on where you live. You can search any of these numbers in the CMS Medicare Coverage Database. The LCDs set the clinical criteria; the CPT codes are how the service is billed. For a plain-language look at coverage, see our Medicare TMS coverage update.
How to read your own statement
- Find the date of service and the code. Match the first date to 90867.
- Count the 90868 lines. They should roughly match your session count, minus any 90869 days.
- Check for a duplicate on the same date. Two TMS codes on one date is worth asking about.
- Look at the allowed amount and your share. What you owe depends on your deductible, copay or coinsurance, not on the code. Our TMS cost and insurance guide explains how those pieces stack.
- If a line is denied, read the reason code. Then see our guide to appealing a TMS denial.
What to do next
Before you start, ask your clinic for the list of codes it plans to bill and confirm those codes are on your authorization. Not sure you’d meet your plan’s criteria? Take our short TMS candidate quiz, then find a clinic near you and ask about insurance before you book.
Your plan’s rules change. This post explains what the codes mean; it can’t tell you what your plan will pay. Check your plan’s current medical policy or call the number on your insurance card.
FAQ
What does CPT 90867 mean?
It’s the initial TMS treatment session code. It covers cortical mapping, motor threshold determination, and the treatment itself, and it’s reported once at the start of a course, according to manufacturer and payer coding guidance. Most patients see it on their first date of service only.
What is the difference between 90868 and 90869?
90868 is a subsequent treatment session without a new motor threshold measurement. 90869 is a subsequent session that includes re-determining the motor threshold. Both include delivery and management of the treatment, and each is billed per session.
Can 90867, 90868 and 90869 be billed on the same day?
A NeuroStar hospital coding guide advises against reporting these codes together. One TMS session should normally produce one TMS code. If you see two on the same date, ask your clinic’s billing office to explain.
Does insurance cover all three TMS codes?
When a plan covers TMS for a patient who meets its criteria, it generally covers the codes that describe the treatment. The details are plan specific. Ask whether all three codes are on your authorization, particularly if your clinic expects to re-check your motor threshold.
Do I need a different code for deep TMS or theta burst?
The three CPT codes describe therapeutic repetitive TMS in general. Plans may have separate rules for deep TMS and theta burst, so confirm that your plan’s policy covers the modality your clinic uses.
Where can I check the official code definitions?
The codes are published by the American Medical Association in the CPT code set. Payer medical policies often reproduce the descriptors, as the Blue Cross Michigan policy linked above does.
