© Copyright 2025 American Medical Association. All rights reserved.
Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, identified by CPT® Code 90869, 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 regions 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 overactive or underactive brain areas; 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 nerve cells, thereby influencing the brain's biochemistry, neuronal firing patterns, and neurotransmitter levels, including serotonin. The initial treatment planning session, coded as 90867, involves the physician determining the optimal sites for coil placement, the ideal rate of stimulating pulses, and the appropriate magnetic energy dosage. The electromagnetic coil is activated to deliver stimulating pulses at a frequency of up to 10 times per second, producing a tapping sound and sensation on the patient's head. The mapping process is critical, as it allows the physician to identify the most effective stimulation site and adjust the pulse rate accordingly. The motor threshold is established by increasing the energy delivered until observable muscle twitches occur, which informs the calculation of the optimal treatment dose. Throughout the treatment course, adjustments to the dose may be necessary based on the patient's response and any side effects experienced. For subsequent treatment sessions where the motor threshold remains unchanged, CPT® Code 90868 is utilized. However, when a re-determination of the motor threshold is required during follow-up sessions, CPT® Code 90869 is applied, ensuring that the optimal level and duration of stimulation are consistently delivered to the patient.
© Copyright 2025 Coding Ahead. All rights reserved.
The therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, represented by CPT® Code 90869, is indicated for the following conditions:
The procedure for therapeutic repetitive transcranial magnetic stimulation (TMS) treatment involves several critical steps, which are outlined as follows:
After the completion of the therapeutic repetitive transcranial magnetic stimulation (TMS) treatment session, patients may experience a range of outcomes. It is essential to monitor the patient for any immediate side effects, which can include mild discomfort at the site of stimulation, headache, or transient changes in mood. Patients are typically advised to resume their normal activities shortly after the procedure, as rTMS is a non-invasive treatment with minimal downtime. Follow-up appointments are crucial for assessing the effectiveness of the treatment and making any necessary adjustments to the stimulation parameters. Continuous evaluation of the patient's response to therapy will guide future treatment sessions and ensure optimal outcomes.
| Short Descr | TCRAN MAGN STIM REDETEMINE | Medium Descr | REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN | Long Descr | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with 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 | 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. | 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. | 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. | 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. | 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 | 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 | 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 | 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 | U6 | Medicaid level of care 6, as defined by each state | U8 | Medicaid level of care 8, as defined by each state | 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 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2012-01-01 | Added | Added |
Get instant expert-level medical coding assistance.