TMS Billing Codes 2026: 90867, 90868, and 90869 Workflow
A 2026 TMS billing workflow for 90867 planning, 90868 treatment delivery, 90869 redetermination, authorization, local coverage, documentation, units, and denials.
On this page: Direct answer
Direct answer
TMS billing codes 2026: what operators need to know
A 2026 TMS billing workflow for 90867 planning, 90868 treatment delivery, 90869 redetermination, authorization, local coverage, documentation, units, and denials. Model TMS as an authorized episode, not a pile of daily claims. Use 90867 once per supported initial planning event under the applicable payer rule.
TMS billing usually centers on three CPT codes: 90867 for initial treatment planning and motor-threshold work, 90868 for subsequent treatment delivery and management, and 90869 for motor-threshold redetermination. The code sequence must match the actual episode, authorization, device and provider requirements, documentation, payer policy, edits, and local coverage.
Medicare coverage for TMS is administered through jurisdiction-specific policies and linked billing articles. Commercial and Medicaid rules can differ in diagnosis, treatment history, session count, retreatment, maintenance, provider, site, device, and authorization. This guide is a workflow aid, not a coverage or coding determination.
Key takeaways
The short version
- Model TMS as an authorized episode, not a pile of daily claims.
- Use 90867 once per supported initial planning event under the applicable payer rule.
- Use 90869 only when a supported redetermination occurs and current pairing rules allow it.
- Reconcile planned, authorized, delivered, missed, redetermined, billed, and paid sessions.
- Verify active Medicare local coverage by jurisdiction and service date.
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Reconcile planning, delivery, redetermination, authorized units, extensions, claims, denials, and episode outcomes.
episode_id,payer,product,jurisdiction,policy_source,policy_version,authorization,approved_codes,approved_start,approved_end,approved_sessions,planning_date,session_date,event_type,code_considered,session_completed,redetermination_reason,cumulative_delivered,remaining_authorized,extension_due,claim_id,claim_status,denial_reason,appeal_deadline,owner,notes ,,,,,,,,,,,,,,,,,,,,,,,,,
1. Map the TMS code to the episode event
| Code | Operational event | Verify before claim |
|---|---|---|
| 90867 | Initial planning, cortical mapping, motor-threshold determination, delivery, and management under the current code | Episode start, qualified supervision, device, documentation, payer frequency, and same-day pairings |
| 90868 | Subsequent treatment delivery and management | Authorized session, attendance, treatment record, provider and device requirements, cumulative count, and date |
| 90869 | Subsequent motor-threshold redetermination with delivery and management | Clinical reason, redetermination documentation, payer frequency, and prohibited or allowed code combinations |
2. Build one source of truth for the TMS episode
- Patient, payer product, jurisdiction, benefit, network, referring or ordering provider, rendering provider, and treatment location
- Diagnosis, severity, treatment history, contraindication review, device, protocol, baseline scale, and current coverage criteria
- Authorization number, approved codes, dates, sessions or units, frequency, site, provider, extension, and expiration
- Planning date, threshold, treatment dates, missed or interrupted sessions, redeterminations, progress scales, response, taper, and episode close
- Each submitted claim, acknowledgment, remittance, correction, denial, appeal, and payment
3. Reconcile care to authorization before each claim
- 01
Verify the episode before scheduling
Confirm coverage, policy, prior treatment evidence, provider, device, site, authorization, approved codes, session count, dates, and expiration.
- 02
Open the planning event
Document the supported 90867 event, threshold, treatment parameters, responsible practitioner, and episode identifier.
- 03
Count delivered sessions
Record each completed 90868 or supported 90869 event; missed, canceled, or interrupted visits do not silently become billed sessions.
- 04
Trigger extension early
Use remaining authorized sessions, expiration, progress evidence, and payer lead time to open continuation review before care is interrupted.
- 05
Validate claim pairings
Run current code-pair edits, payer frequency rules, ordering data, diagnosis, provider and site requirements, and documentation checks.
- 06
Close the episode
Reconcile authorized, delivered, billed, denied, paid, and remaining sessions; preserve outcome and retreatment eligibility evidence.
4. Regression-test the TMS claim logic
| Scenario | Expected behavior | Failure prevented |
|---|---|---|
| First session | Supported planning event reports the applicable initial code once | Duplicate 90867 |
| Routine treatment | Completed session increments delivery, authorization, and claim counts together | Billing a missed session |
| Threshold change | Clinical reason and redetermination are documented before 90869 is considered | Unsupported redetermination |
| Same-day pairing | Current payer and edit rules determine allowed reporting | 90867, 90868, or 90869 conflict |
| Authorization expiration | Scheduling or claim holds and extension workflow opens | Care or billing outside approved dates |
| Retreatment | New policy, response history, interval, authorization, and episode are verified | Prior approval copied into a new course |
5. Route denials to the evidence that can resolve them
- Eligibility, network, provider, or site denial: benefits and credentialing evidence
- Authorization or unit denial: approval, session ledger, dates, extension, and payer correspondence
- Frequency or pairing denial: current edit, code source, episode timeline, and treatment record
- Medical-necessity denial: active policy, criterion-mapped record, treatment history, scale results, and clinician review
- Ordering or documentation denial: referral data, NPI, signed note, device, protocol, and service-date record
- Timely-filing or duplicate denial: acceptance evidence, original claim control number, correction chain, and deadline source
Common questions
Answers before you build.
What are the main TMS billing codes in 2026?+
The common CPT sequence is 90867 for initial planning, 90868 for subsequent treatment delivery, and 90869 for a supported motor-threshold redetermination. Current payer and code-set rules govern exact use.
Can 90867 be billed more than once?+
Some Medicare contractor guidance expects it once per treatment episode. A new or repeated planning service still needs support under the active payer policy, frequency rule, and documentation.
Can 90869 be billed with 90868?+
Do not assume so. Current Medicare contractor articles include pairing restrictions. Run the applicable payer and edit rules for the service date and document the redetermination.
Does TMS authorization guarantee payment?+
No. The claim must still satisfy eligibility, network, provider, site, code, frequency, diagnosis, documentation, edits, and timely-filing requirements.
Practical closeout
Use this operator checklist.
- Model TMS as an authorized episode, not a pile of daily claims.
- Use 90867 once per supported initial planning event under the applicable payer rule.
- Use 90869 only when a supported redetermination occurs and current pairing rules allow it.
- Reconcile planned, authorized, delivered, missed, redetermined, billed, and paid sessions.
- Verify active Medicare local coverage by jurisdiction and service date.
Continue through the cluster
Verified customer case studies are added only with customer permission and supporting evidence; none is implied by these operational examples.
Sources & methodology
Trace the operational claims.
Marsa Health Editorial reviewed the primary and research sources below on July 28, 2026. We translate them into workflow controls, distinguish proposals from final rules, and flag where plan, program, state, contract, or clinical requirements vary.
- 01Billing and Coding: Transcranial Magnetic Stimulation Centers for Medicare & Medicaid ServicesCurrent Medicare contractor article reviewed in July 2026, with episode, claim, documentation, and local-coverage considerations.Accessed or rechecked July 28, 2026
- 02Billing and Coding: TMS in Adults With Major Depressive Disorder Centers for Medicare & Medicaid ServicesJurisdiction-specific Medicare billing article illustrating planning, delivery, redetermination, ordering, and documentation controls.Accessed or rechecked July 28, 2026
- 03Medicare Coverage Database Centers for Medicare & Medicaid ServicesOfficial search for current national and local Medicare coverage documents by service, jurisdiction, status, and effective version.Accessed or rechecked July 28, 2026
- 04HCPCS Quarterly Update Centers for Medicare & Medicaid ServicesOfficial quarterly HCPCS files, including the July 2026 alpha-numeric update current when this guide was reviewed.Accessed or rechecked July 28, 2026
- 05National Correct Coding Initiative for Medicare Centers for Medicare & Medicaid ServicesOfficial NCCI hub with current policy, edit files, modifier education, and appeal routing.Accessed or rechecked July 28, 2026
- 06Autism services Medicaid.govFederal Medicaid overview and guidance collection on autism services; state coverage and operational requirements vary.Accessed or rechecked July 28, 2026
- 07CMS Interoperability and Prior Authorization Final Rule CMS-0057-F Centers for Medicare & Medicaid ServicesCurrent implementation dates, decision timeframes, denial-reason requirements, metrics, and API provisions for impacted payers.Accessed or rechecked July 28, 2026
- 08Minimum Necessary Requirement U.S. Department of Health and Human ServicesHIPAA guidance on limiting uses, disclosures, and requests for protected health information when the standard applies.Accessed or rechecked July 28, 2026
Organizational author. Editorial review covers source accuracy, search intent, workflow boundaries, and human-oversight requirements. This material is educational and does not provide clinical, legal, coding, or coverage advice.
No named clinical or legal expert reviewer is attributed to this version. Marsa Health does not invent reviewer credentials.
Read our editorial methodRevision history
What changed and when
July 28, 2026
Initial publication, source review, and operational editing.