Does 90867 require prior authorization?

No, 90867 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 90867?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

All documentation must be maintained in the patient’s medical record, be legible, include patient identification and dates of service, and contain the legible signature of the responsible treating physician or non‑physician practitioner.
Medical record documentation must support the medical necessity of TMS services as directed in this policy and be available to the contractor upon request.
The attending physician must monitor and document the patient's clinical progress using validated depression rating scales (GDS, PHQ‑9, BDI, HAM‑D, MADRS, QIDS, or IDS‑SR) to assess treatment response and remission.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Transcranial Magnetic Stimulation (TMS) is covered when provided using an FDA‑approved device for the treatment of depressive disorders and delivered according to current medical standards of practice.
Initial TMS treatment is allowed for up to 20 visits over a 4‑week period followed by up to 5 tapering visits for patients who achieve remission.
If a patient shows at least a 25% improvement on validated depression rating scales, therapy may be continued for an additional 2 weeks (up to 10 additional visits) with an additional 6 tapering visits.
Retreatment (repeat treatment program) may be considered for patients who previously met initial treatment guidelines and subsequently relapse if prior response demonstrated >50% improvement on standard depression rating scales or if relapse occurred after remission.
Transcranial Magnetic Stimulation (TMS) is covered for the treatment of adults with Major Depressive Disorder per LCD L34998.
TMS is covered when provided using a device approved or cleared by the U.S. Food and Drug Administration for transcranial magnetic stimulation.

A57598 — Billing and Coding: Transcranial Magnetic Stimulation (TMS)

J05

L34641 — Transcranial Magnetic Stimulation (TMS)

J05

A57528 — Billing and Coding: Transcranial Magnetic Stimulation

J06

L33398 — Transcranial Magnetic Stimulation

J06

L34522

Ask Verity about documentation requirements, denial risks, or coverage in your state.