Summary & Overview
CPT 90867: Initial Transcranial Magnetic Stimulation Treatment
CPT code 90867 denotes the initial transcranial magnetic stimulation (TMS) treatment session that encompasses cortical mapping, motor threshold determination, delivery of stimulation, and session management. TMS is an FDA-cleared, noninvasive neuromodulation therapy used to treat major depressive disorder when patients have not responded to prior therapies. Nationally, use of TMS has grown as clinical guidelines and payer coverage policies evolve, making accurate coding for the initial setup and delivery important for clinical documentation and claims processing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of where CPT code 90867 is applied clinically, typical sites of service, and common billing considerations. The publication also highlights benchmark utilization patterns, reimbursement and coverage policy updates from major payers, and clinical context that clarifies when the initial TMS procedure is reported separately from subsequent treatment sessions. Data not available in the input for some specifics will be noted accordingly.
Billing Code Overview
CPT code 90867 describes a transcranial magnetic stimulation (TMS) initial treatment that includes cortical mapping, motor threshold determination, treatment delivery, and session management. This procedure uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
Service type: Procedural neurostimulation for major depressive disorder (initial TMS setup and delivery)
Typical site of service: Outpatient specialty clinic or hospital outpatient department where TMS equipment and trained staff are available
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient with treatment-resistant major depressive disorder (unipolar), who has failed adequate trials of two antidepressant medications and psychotherapy, is referred for transcranial magnetic stimulation (TMS). The clinical workflow begins with an initial outpatient consultation by a psychiatrist or neuromodulation specialist to confirm indications, obtain informed consent, and review contraindications (e.g., implanted metallic devices in the head). On the same visit or a scheduled planning visit, cortical mapping and motor threshold determination are performed to identify the stimulation target and appropriate intensity. The initial TMS session includes setup, coil positioning, delivery of stimulation parameters (per protocol), and device/patient monitoring. Typical sessions occur in an ambulatory specialty clinic or hospital outpatient department with the patient conscious and monitored for tolerability. Documentation includes indication, mapping results (motor threshold), stimulation parameters, total pulses delivered, device used, adverse events, and care coordination notes for follow-up treatment sessions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default — No modifier | Used when no special circumstances apply to the service |
22 |