TMS Billing: CPT Codes 90867, 90868 and 90869, Prior Authorization and Coverage Criteria

TMS is billed with three CPT codes: 90867 for the first treatment (with mapping and motor threshold), 90868 for each following session, and 90869 for a session that includes re-determining the motor threshold. Nearly every payer requires prior authorization, usually for a set number of sessions, and coverage depends on documented failed medication trials, psychotherapy and standardized depression scores.

TMS claims are simple to code and easy to lose: most denials come from sessions delivered beyond the authorization, or authorizations requested without the documentation payers ask for.

The codes

Code	Description	How often
90867	Therapeutic repetitive TMS treatment; initial, including cortical mapping, motor threshold determination, delivery and management	Once, at the start of a course
90868	Subsequent delivery and management, per session	Each routine session
90869	Subsequent motor threshold re-determination with delivery and management	Sessions where the threshold is re-measured

Bill one code per session. A session with a new motor threshold is 90869, not 90868 plus something else.

Typical coverage criteria for depression

Criteria differ by payer, and Medicare coverage depends on the local coverage determination of your Medicare Administrative Contractor. Most policies include:

• A diagnosis of major depressive disorder (often severe, without psychotic features)
• Failed antidepressant trials: commonly two to four medications at adequate dose and duration, or intolerance to them
• A trial of evidence-based psychotherapy
• A standardized depression scale (such as PHQ-9, HAM-D or Beck Depression Inventory) documenting severity before treatment
• No exclusions such as certain implanted metal devices or active seizure risks

TMS devices also have FDA clearances for other conditions, such as obsessive-compulsive disorder, but payer coverage outside depression is more limited. Check the policy before offering it to insured patients.

Authorization and session tracking

1. Request authorization with the payer’s criteria documented, including dates and doses of prior medications.
2. Record the number of sessions and the date range approved.
3. Track sessions delivered against sessions approved, every day.
4. Request extensions before the last approved session, with updated depression scores showing response.
5. For retreatment after a successful course, expect a new authorization with evidence of the earlier response.

Documentation for each session

• Motor threshold and treatment parameters (for 90867 and 90869)
• Coil placement, pulses delivered and session duration
• Patient tolerance and any side effects
• The supervising physician’s involvement as the payer requires
• Periodic depression scale scores showing progress

Common TMS denials

Denial	Cause	Fix
Sessions beyond authorization	Treatment continued after the approved number or dates	Daily session count against the authorization
Criteria not met	Medication history or scale scores missing from the request	Build the request from the payer’s policy checklist
90867 billed twice	Initial code used again for re-mapping	Use 90869 for threshold re-determination
Retreatment denied	No documented response to the first course	Document scores at start, midpoint and end of every course

Many practices offering TMS also offer Spravato. See our Spravato billing guide and our page for Osmind practices.

Payer policies and coverage criteria change. We check each payer’s current policy before requesting authorization. Our psychiatry billing team handles TMS authorizations, session tracking and claims.

Frequently asked questions