TMS CPT Codes for 2026
Getting CPT codes right is the difference between getting paid and getting denied. Wrong code usage is the number one reason TMS claims fail. Here’s what you need to know.
Primary TMS Treatment Codes
| CPT Code | Description | Typical Use |
|---|---|---|
| 90867 | TMS treatment delivery — initial session (includes motor threshold mapping) | First session of a treatment course |
| 90868 | TMS treatment delivery — subsequent session | Sessions 2 through end of treatment course |
| 90869 | TMS treatment delivery — subsequent session with re-mapping | When motor threshold needs recalibration |
Key Points
- 90867 gets used once per treatment course — at the initial mapping and first treatment session
- 90868 is the workhorse. You’ll bill this for the vast majority of sessions (typically 35 out of 36)
- 90869 is for clinical re-mapping only (patient reports changed sensation, new medications affect threshold, etc.)
Evaluation and Management Codes
Bill these separately from TMS treatment codes when a physician provides an E/M service on the same day:
| CPT Code | Description | When to Use |
|---|---|---|
| 99213 | Established patient, low complexity | Brief check-in during TMS course |
| 99214 | Established patient, moderate complexity | Medication adjustment, symptom review |
| 99215 | Established patient, high complexity | Complex clinical decision-making |
Key detail: Use modifier -25 on E/M codes billed the same day as TMS. This tells the payer it’s a separately identifiable service.
2026 Medicare Reimbursement Rates
| CPT Code | National Average | Range by Region |
|---|---|---|
| 90867 | $148–$165 | $130–$195 |
| 90868 | $83–$95 | $72–$115 |
| 90869 | $125–$140 | $110–$165 |
Commercial payer rates typically run 120–200% of Medicare, depending on the carrier and your negotiated contract.
Common Billing Mistakes
1. Using 90867 for Multiple Sessions
90867 includes motor threshold mapping. It’s for the initial session only. Every session after that should be 90868, unless re-mapping is clinically indicated.
2. Missing Modifier -25 on E/M Codes
If a physician sees the patient for a separate evaluation the same day as TMS, the E/M code needs modifier -25. Without it, the claim gets denied as bundled.
3. Billing for Cancelled Sessions
Patient shows up but treatment doesn’t happen (device malfunction, too anxious to start)? You cannot bill 90868. Document the reason and reschedule.
4. Not Documenting Medical Necessity for Re-Mapping
90869 requires clinical justification. Running periodic re-maps without documented reasons will trigger denials and put you on audit radar.
5. Incorrect Place of Service
TMS is almost always billed as Place of Service 11 (office). Using POS 22 (hospital outpatient) when you’re treating in a private office will get denied.
Prior Authorization Requirements
Most payers require prior authorization before TMS begins. The auth typically covers:
- Diagnosis — MDD (ICD-10: F33.1 or F33.2) is the most commonly approved
- Treatment failure documentation — 2–4 failed medication trials at adequate dose and duration
- Treatment plan — number of sessions, frequency, device to be used
- Re-authorization — some payers require re-auth after 18–20 sessions
ICD-10 Codes Commonly Used with TMS
| ICD-10 | Description |
|---|---|
| F33.1 | Major depressive disorder, recurrent, moderate |
| F33.2 | Major depressive disorder, recurrent, severe without psychotic features |
| F42.2 | OCD, mixed obsessional thoughts and acts |
| F43.10 | Post-traumatic stress disorder, unspecified |
Revenue Optimization Tips
- Track denial rates by payer — if a carrier denies more than 10% of clean claims, it’s time to renegotiate or escalate
- Appeal every bad denial — TMS denial overturn rates on appeal run 60–70%
- Bill E/M codes when they apply — don’t leave money on the table by skipping physician evaluations
- Verify benefits before starting treatment — confirm TMS is covered under the patient’s specific plan, not just the carrier in general
- Consider a TMS-specialized billing service — the coding details make outsourcing worthwhile for many practices
Frequently Asked Questions
What’s the difference between CPT codes 90867, 90868, and 90869?
90867 covers the initial session including motor threshold mapping — used once per treatment course. 90868 is for all subsequent treatment sessions. 90869 covers re-mapping when clinically indicated (e.g., medication changes affecting threshold). Never bill 90867 for every session; this triggers denials and audits.
Does Medicare cover TMS in 2026?
Yes. Medicare covers TMS for major depressive disorder under its current LCD (Local Coverage Determination). Coverage requires a diagnosis of MDD, documented treatment resistance (typically 4 prior medication trials), and a PHQ-9 score of 10 or higher. Most Medicare Advantage plans follow Medicare guidelines.
Why do TMS claims get denied most often?
The three most common reasons: (1) insufficient documentation of medication trials — payers want records of at least 4 prior medication attempts; (2) missing or incorrect CPT modifiers — E/M codes need modifier -25 when billed same-day as TMS; (3) billing at wrong place of service — TMS should almost always be POS 11 (office), not POS 22 (hospital outpatient).
What is modifier -25 and when is it required?
Modifier -25 on E/M codes tells the payer that a separately identifiable evaluation and management service occurred the same day as TMS. If your psychiatrist reviews medications, adjusts treatment parameters, or addresses a new complaint during a visit that also includes TMS treatment, bill the E/M with -25. Without it, the payer bundles the E/M into the TMS code and denies it.
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Additional Resources
For Clinic Operators
For questions about specific legal or regulatory requirements in your state, consult with a healthcare attorney familiar with neuromodulation practices. The legal landscape for TMS is evolving rapidly as the technology becomes more mainstream.