TMS Billing Services

Why TMS Billing Needs Specialization

TMS billing isn’t like billing for a therapy session. The CPT codes are specific. Prior authorization is almost always required. Denial rates run higher than standard psychiatric services. If your billing team doesn’t understand TMS, you’re leaving money on the table — sometimes a lot of it.

What TMS Billing Involves

Prior Authorization

Before session one, insurance has to say yes. That means:

• Submitting clinical documentation (diagnosis, medication history, PHQ-9 scores)
• Meeting carrier-specific criteria (typically 2–4 failed medication trials)
• Tracking auth status and chasing down delays
• Managing re-authorization for extended or maintenance treatments

Claims Submission

Every TMS session generates a claim:

• CPT 90867 — initial session with motor threshold mapping
• CPT 90868 — subsequent sessions (this is the bulk of your billing)
• CPT 90869 — sessions requiring re-mapping
• E/M codes with modifier -25 when a physician evaluation happens same-day

Denial Management

TMS denial rates run 10–25% depending on the carrier. The usual suspects:

• Not enough documentation of failed medication trials
• Missing prior authorization
• Wrong CPT code
• Coding errors (wrong modifier, wrong place of service)
• Medical necessity not established

Appeals

Here’s the good news: TMS appeals have a high overturn rate — 60–70% when done right. That includes:

• Peer-to-peer reviews with carrier medical directors
• Written appeals backed by additional clinical documentation
• External review requests when internal appeals run out

In-House vs. Outsourced Billing

What to Look for in a TMS Billing Service

Ask the hard questions:

• TMS-specific experience — how many TMS practices do they bill for right now?
• Prior auth management — do they handle the full process or just claims?
• Denial follow-through — what’s their overturn rate?
• Reporting — do you get monthly reports on collections, denials, and aging?
• Turnaround time — how fast do claims go out after the date of service?
• References — can they connect you with current TMS clinic clients?

Key Metrics to Track

• Days in A/R (accounts receivable) — target under 35 days
• Clean claim rate — target above 95%
• Denial rate — target under 10%
• Collection rate — target above 92% of allowed amounts
• Prior auth turnaround — target under 10 business days

Getting Started

Why TMS List?

TMS List is the most comprehensive TMS therapy directory worldwide, connecting patients with verified providers across 20+ countries. We don’t accept payment to influence rankings, all reviews come from real patients, and clinic information is regularly verified.

Whether you’re a patient researching treatment or a clinic looking to grow, our platform helps match the right people with the right providers. Contact us to learn more about how we can help.

Getting Started

Why TMS List?

TMS List is the most comprehensive TMS therapy directory worldwide, connecting patients with verified providers across 20+ countries. We don’t accept payment to influence rankings, all reviews come from real patients, and clinic information is regularly verified.

Whether you’re a patient researching treatment or a clinic looking to grow, our platform helps match the right people with the right providers. Contact us to learn more about how we can help.