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Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, as described by CPT® Code 90867, is a non-invasive procedure primarily utilized for the management of depression in patients who have not responded to other therapeutic interventions. This innovative treatment modality employs magnetic fields to stimulate nerve cells in specific areas of the brain that are associated with mood regulation and other psychological disorders. Conditions such as anxiety, obsessive-compulsive disorder, auditory hallucinations, and migraines may also be addressed through this technique. The underlying principle of rTMS is to modulate the activity of brain regions that may be either overactive or underactive; for instance, individuals with depression often exhibit reduced activity in the left prefrontal cortex. During the procedure, a large electromagnetic coil is positioned against the scalp over the targeted brain region. This coil generates painless electric currents that stimulate the underlying nerve cells, thereby influencing the brain's biochemistry, neuronal firing patterns, and neurotransmitter levels, including serotonin. The initial session, as indicated by code 90867, encompasses several critical components: cortical mapping, motor threshold determination, and the delivery and management of the treatment. The physician conducts a thorough assessment to identify the most effective sites on the forehead for magnet placement, determines the optimal rate of stimulating pulses, and calculates the appropriate dose of magnetic energy required for effective treatment. The process involves activating the electromagnetic coil at a frequency of up to 10 times per second, producing a tapping or clicking sound and a corresponding tapping sensation on the patient's head. This comprehensive approach ensures that the treatment is tailored to the individual needs of the patient, with adjustments made as necessary based on their response and any side effects experienced during the course of therapy.
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The therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, represented by CPT® Code 90867, is indicated for the following conditions:
The procedure for therapeutic repetitive transcranial magnetic stimulation (TMS) treatment involves several key steps that are essential for effective treatment delivery:
After the completion of the initial therapeutic repetitive transcranial magnetic stimulation (TMS) session, patients may experience some mild side effects, such as headache or scalp discomfort, which typically resolve shortly after the procedure. Continuous monitoring of the patient's response to treatment is essential, and adjustments to the stimulation parameters may be made in subsequent sessions as needed. It is important for the physician to evaluate the effectiveness of the treatment and to determine if further sessions are required. For subsequent delivery and management sessions where the motor threshold does not require adjustment, CPT® Code 90868 should be used. If motor threshold re-determination is necessary during follow-up sessions, CPT® Code 90869 is applicable. This structured approach ensures that patients receive optimal care tailored to their specific treatment needs.
| Short Descr | TCRANIAL MAGN STIM TX PLAN | Medium Descr | REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M | Long Descr | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management | Status Code | Carriers Price the Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | Z2 - Undefined codes | MUE | 1 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | U6 | Medicaid level of care 6, as defined by each state | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AF | Specialty physician | AH | Clinical psychologist | AJ | Clinical social worker | AM | Physician, team member service | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GJ | "opt out" physician or practitioner emergency or urgent service | GT | Via interactive audio and video telecommunication systems | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | Q2 | Demonstration procedure/service | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Medium Descriptor changed. Guideline information changed. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Added | Added |
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