90868
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The ordering provider name and NPI must be included on the claim: for Part A use UB-04 Block 78/79 or EMC 2420B; for Part B use paper Block 17A/17B or EMC 2310A or 2420F.
- All documentation must be maintained in the medical record, be legible, include complete patient identification (e.g., full name, dates of service), and contain the legible signature of the physician or non-physician practitioner responsible for care.
- Submitted medical records must support the selected ICD-10-CM code(s) and demonstrate that the submitted CPT/HCPCS code accurately describes the service performed.
- Medical record documentation must support that the attending physician met face-to-face with the patient for the initial assessment and for subsequent management when there is a change in mental status or other significant clinical change.
Key Coverage Criteria
- 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.
- Retreatment (repeat treatment program) may be considered for patients who met the guidelines for initial TMS and subsequently relapse if the patient previously responded to treatment with >50% improvement on standard depression rating scales or if relapse occurred after remission.
- Transcranial magnetic stimulation (TMS) is covered for treatment of depressive symptoms when administered using an FDA‑approved TMS device and when medical necessity is documented in the medical record.
- Retreatment (a repeat treatment program) is allowed for patients who previously met initial treatment guidelines and subsequently develop relapse of depressive symptoms if the patient previously responded to treatment with >50% improvement on a standard depression rating scale or if relapse occurred after remission.
- Transcranial Magnetic Stimulation (TMS) is covered for the treatment of adults (age >=18) with Major Depressive Disorder in accordance with LCD L34522 reasonable and necessary requirements.
20 Active Policies
L34641 — Transcranial Magnetic Stimulation (TMS)
J05
A57598 — Billing and Coding: Transcranial Magnetic Stimulation (TMS)
J05
A57528 — Billing and Coding: Transcranial Magnetic Stimulation
J06
L33398 — Transcranial Magnetic Stimulation
J06
L34522
Related Codes
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