TMS billing: CPT codes, coverage, and authorization limits
TMS payment depends on the service code, the plan's coverage policy, and any authorization limits. A treatment course can run out of approved units before its date window ends.
When a plan requires TMS authorization, its approval defines the covered codes, units, dates, and provider details for a course. A claim can still fail after approval if the billed session falls outside those terms.
Start with the service actually performed
| Code | Use | What the record should show |
|---|---|---|
| 90867 | Initial treatment planning and delivery, including mapping and motor-threshold determination | The initial work performed for this course |
| 90868 | Subsequent treatment delivery and management | The session delivered and the remaining authorization |
| 90869 | Subsequent motor-threshold redetermination with treatment | Why redetermination was needed and what was performed |
Check same-day edits and the applicable payer policy when selecting codes. Aetna's TMS policy provides a current code reference; inclusion of a code does not establish coverage for every indication.
An authorization requirement is plan-specific
Evernorth removed TMS prior authorization on March 6, 2026 for contracted providers treating patients covered by the specified Evernorth and Cigna Healthcare plans. Evernorth's provider notice defines the scope. Check the member's plan, network, and benefit administrator rather than assuming all TMS requires authorization.
For Original Medicare, identify the applicable MAC policy and its billing article. Covered diagnoses, documentation, repeat treatment, and utilization limits must all be checked. A diagnosis-code match alone is insufficient.
A local policy shows why one session cap is unsafe
Noridian's article A57692 describes up to 20 initial visits over four weeks, followed by five tapering visits for patients in remission. Patients showing at least 25% improvement may receive ten additional treatment visits over two weeks and six tapering visits. This is a local policy example, checked September 13, 2026.
Two paths in Noridian's utilization guidance
- Treatment plus taper
Record symptom scores before treatment and at the policy's required checkpoints. Continuation depends on documented response. If a course slips outside its approved dates, unused units alone do not authorize more treatment.
Keep the authorization usable through the last claim
- 01Capture approvalStore the source determination, dates, codes, units, and provider details.
- 02Record treatmentLog the service date and units against the appropriate code.
- 03Review remaining treatmentCompare scheduled sessions with both the unit balance and the end date.
- 04Prepare continuationObtain response evidence and request additional treatment before a gap occurs.
A changed dose, protocol, provider, or setting deserves a policy check. Keep the clinical decision with the treating clinician and the coverage decision with the applicable plan. Neither is established by an appointment on the calendar.
How Foresight helps
Foresight stores an authorized course with units per code, its validity window, and the authorization number. Recorded utilization provides a remaining balance that staff can trace to individual service dates. Review tasks surface approaching exhaustion and renewal work.
Before submission, Foresight links required authorizations to claims and checks approval and expiration. Structured treatment histories and symptom scores give the coordinator evidence for continuation. The same record supports the initial request and the next review, without rebuilding the history from scattered notes.
For the wider renewal process, see how to track authorization expiration.
01How many TMS sessions does insurance cover?
Use the member's policy and any issued authorization. Limits differ by plan and treatment circumstances; a clinic's usual course is not a coverage limit.
02Is maintenance TMS covered?
Check the specific policy. Noridian A57692 excludes maintenance, while its criteria for repeat treatment after relapse describe a separate situation.