TMS CPT codes
& billing guide.
Complete billing and reimbursement reference for TMS therapy providers. CPT codes, ICD-10 diagnoses, Medicare rates, and authorization guidance.
TMS CPT Codes
Therapeutic repetitive TMS treatment; initial, including cortical mapping, motor threshold determination, delivery and management, first session
Billed once per treatment course. Includes motor threshold determination and cortical mapping.
Therapeutic repetitive TMS treatment; subsequent delivery and management, per session
Billed for each session after the initial. Typical course is 36 sessions over 6-9 weeks.
Therapeutic repetitive TMS treatment; subsequent motor threshold re-determination with delivery and management
Used when motor threshold must be re-established mid-course due to clinical need.
ICD-10 Diagnosis Codes
Prior Authorization Tips
- 1 Start early. Submit prior authorization at least 2-3 weeks before the planned start date. Some payers take up to 15 business days to respond.
- 2 Document medication failures. Include dates, dosages, duration, and reason for discontinuation for at least two antidepressant trials at adequate dose and duration.
- 3 Include validated rating scales. PHQ-9, HAM-D, or BDI scores demonstrating moderate-to-severe depression are essential for approval.
- 4 Specify the protocol. Include the device, coil type, treatment location (left DLPFC), frequency, pulse count, and number of planned sessions.
- 5 Know your payer. Medicare generally covers TMS for treatment-resistant depression. Commercial payers vary — always check the specific medical policy.
Common Denials & Appeal Strategies
Medical necessity not established
Appeal strategy: Document at least two failed adequate antidepressant trials (minimum 8 weeks at therapeutic doses). Include PHQ-9 or HAM-D scores showing persistent moderate-to-severe depression.
Experimental or investigational
Appeal strategy: Cite FDA clearances (2008 for depression, 2018 for OCD) and APA Clinical Practice Guidelines. Reference the STAR*D trial outcomes for treatment-resistant depression.
Prior authorization not obtained
Appeal strategy: Always obtain prior auth before starting treatment. Most payers require it. Build in 2-3 weeks lead time. Submit clinical notes, medication history, and rating scale scores.
Incorrect coding or documentation
Appeal strategy: Ensure the supervising psychiatrist signs off on each treatment note. Use 90867 for the first session only, 90868 for subsequent sessions. Include session duration and pulse count.
Exceeded session limits
Appeal strategy: Most payers authorize 36 sessions. If additional sessions are needed, submit a request for continuation with updated clinical documentation showing partial but incomplete response.
Billing Disclaimer
This guide is for informational purposes only and does not constitute billing or legal advice. Reimbursement rates and payer policies change frequently. Always verify current rates with your Medicare Administrative Contractor (MAC) or commercial payer. Consult a healthcare billing professional for practice-specific guidance.
For TMS Providers
List Your Clinic on TMS List
Reach patients searching for TMS therapy in your area. Free basic listings available for all verified providers.