Coding and Billing for NeuroStar TMS Therapy®

Current Procedural Terminology (CPT)1

Several NeuroStar CPT codes may be used for reporting the various services related to the delivery of NeuroStar TMS Therapy.

NeuroStar TMS Therapy Category I CPT Codes

CPT Code Description
90867

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management

(Report only once per course of treatment)
(Do not report 90867 in conjunction with 90868, 90869, 95860-95870, 95928, 95929, 95939)
90868 Subsequent delivery and management, per session
90869 Subsequent motor threshold re-determination with delivery and management(Do not report 90869 in conjunction with 90867, 90868, 95860-95870, 95928, 95929, 95939)

NeuroStar Code Usage for a Physician: The AMA created three distinct CPT codes for coding and billing purposes to report TMS Therapy to an insurance carrier.CPT code 90867 was created to report treatment planning services during the initial patient visit. This includes determining the patient’s cortical neuron excitability or motor threshold (MT) value, determining and storing the cortical landmark coordinates corresponding to the location were MT was determined, determining and storing the treatment location coordinates, and selecting and storing treatment parameters for a given treatment protocol and the first treatment and delivery session. CPT code 90868 was created to report services for each session when treatment is delivered and patient management services are provided. For the initial visit (day one of TMS Therapy) when a treatment planning session and a treatment delivery session is completed, 90867 would include both services for the same day. On subsequent treatment days, when only treatment delivery and management is provided, only 90868 would be reported. CPT code, 90869, was created for those individual patient cases when re-determining the motor threshold (MT) is clinically appropriate.

➢ Bill only one NeuroStar® TMS Therapy Code for each patient per day.
➢ Sometimes, services other than NeuroStar TMS Therapy are performed on the same date. It may be appropriate for those services to be reported in addition to NeuroStar TMS Therapy.

Refer to the PHYSICIAN Coding Reference Guide for TMS Therapy for additional details.

Code Usage for a Hospital: For the Hospital Outpatient Setting (Place of Service 22). Medicare has assigned CPT Codes 90867-90869 to APC 0216.2

Refer to the HOSPITAL Coding Reference Guide for TMS Therapy for additional details.

Certain guidelines have been outlined for TMS Therapy codes. Please verify these guidelines with the proper coding resources, the individual insurance carrier and the patient’s specific plan.

 

  1. 2013 CPT Current Procedural Terminology Professional Edition, American Medical Association.
  2. Regulation No.: CMS 1589-FC Federal Register/Vol. 77, No. 221/Thursday, November 15, 2012/Rules and Regulations

CPT is a Registered Trademark of the American Medical Association.

Please Note: The information contained provided is for educational purposes only. It is intended to assist providers and/or hospitals in accurately obtaining reimbursement for healthcare services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult the specific payer with regard to local reimbursement policies. The information, including all CPT® & HCPCS billing codes, contained in this guide represents no statement, promise or guarantee by Neuronetics concerning levels of reimbursement, payment, or charge. It is always the provider’s and/or hospital’s responsibilities to determine and submit appropriate codes for the services rendered.