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Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive therapeutic procedure primarily utilized for the treatment of depression in patients who have not responded to other treatment options. This innovative technique may also be applied to address various other mental health conditions, including anxiety disorders, obsessive-compulsive disorder (OCD), auditory hallucinations, and migraines. The underlying principle of rTMS involves the modulation of brain activity, particularly in areas that may be overactive or underactive in relation to specific disorders. For instance, individuals suffering from depression often exhibit reduced activity in the left prefrontal cortex, a region associated with mood regulation. The procedure employs magnetic fields to stimulate nerve cells in targeted regions of the brain, effectively altering the brain's biochemistry and influencing the firing patterns of neurons. This stimulation is achieved through the use of a large electromagnetic coil, which is positioned against the scalp over the designated area of the brain. When activated, the coil generates painless electric currents that stimulate the nerve cells, resulting in a tapping or clicking sound and a corresponding tapping sensation on the head. In the initial planning and management session, as described in CPT® Code 90867, the physician identifies the optimal sites for magnet placement, determines the ideal rate of stimulating pulses, and calculates the appropriate dose of magnetic energy required for effective treatment. This mapping process involves adjusting the position of the electromagnetic coil and varying the pulse rate until the motor threshold is established, which is the point at which muscle twitching occurs. Once this threshold is determined, the physician can calculate the optimal dose for subsequent treatments. CPT® Code 90868 is specifically designated for each subsequent delivery and management session where the motor threshold does not require adjustment. During these follow-up sessions, the magnets are reapplied to the head, and the previously established optimal level and duration of stimulation are administered. In cases where re-determination of the motor threshold is necessary, CPT® Code 90869 is utilized. This structured approach ensures that the treatment is tailored to the individual needs of the patient, enhancing the overall effectiveness of rTMS therapy.
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The therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, as described by CPT® Code 90868, is indicated for the following conditions:
The procedure for therapeutic repetitive transcranial magnetic stimulation (TMS) involves several key steps, which are outlined as follows:
After the completion of each rTMS session, patients may experience mild side effects, such as headache or scalp discomfort, which typically resolve shortly after the procedure. It is important for patients to follow any post-procedure care instructions provided by the physician. Continuous monitoring of the patient's response to treatment is essential, and adjustments to the stimulation parameters may be made in subsequent sessions if required. The overall recovery process is generally quick, allowing patients to resume their daily activities shortly after each session. Regular follow-up appointments are necessary to assess the effectiveness of the treatment and make any necessary modifications to the therapy plan.
| Short Descr | TCRANIAL MAGN STIM TX DELI | Medium Descr | THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG | Long Descr | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session | 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 | 2 | 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. | AF | Specialty physician | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CR | Catastrophe/disaster related | 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. | U6 | Medicaid level of care 6, as defined by each state | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GJ | "opt out" physician or practitioner emergency or urgent service | AM | Physician, team member service | GA | Waiver of liability statement issued as required by payer policy, individual case | HB | Adult program, non geriatric | GW | Service not related to the hospice patient's terminal condition | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | Q2 | Demonstration procedure/service | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | SA | Nurse practitioner rendering service in collaboration with a physician | 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. | 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). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AJ | Clinical social worker | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | EM | Emergency reserve supply (for esrd benefit only) | FQ | The service was furnished using audio-only communication technology | GC | This service has been performed in part by a resident under the direction of a teaching physician | GT | Via interactive audio and video telecommunication systems | KX | Requirements specified in the medical policy have been met | UD | Medicaid level of care 13, as defined by each state | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Added | Added |
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