CPT 90868 TMS Subsequent Session Reimbursement

CPT code 90868 covers the subsequent delivery and management of transcranial magnetic stimulation (TMS), a noninvasive neuromodulation therapy that uses magnetic fields to stimulate brain nerve cells and improve symptoms of depression. As TMS becomes more widely available, accurate coding of subsequent sessions is important for consistent claims processing and national billing visibility. This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of what 90868 represents clinically and operationally, payer coverage considerations, typical sites of service, and common modifiers used with this type of service. The publication summarizes reimbursement benchmarks, utilization context, and recent policy updates affecting TMS delivery and billing where available. It also provides practical billing characteristics that payers and providers reference when submitting claims for subsequent TMS sessions. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 90868 describes the subsequent delivery and management of transcranial magnetic stimulation (TMS). This procedure uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.

Service type: Repetitive transcranial magnetic stimulation (rTMS) therapy delivery and session management
Typical site of service: Outpatient behavioral health clinics, psychiatric centers, or ambulatory procedure suites where TMS devices are available

Clinical Context

A 42-year-old patient with treatment-resistant major depressive disorder presents to an outpatient psychiatric specialty clinic for ongoing transcranial magnetic stimulation (TMS) therapy. The patient previously completed a course of daily TMS sessions with documented partial response and is scheduled for subsequent, maintenance or continuation TMS sessions. Before each session, a trained clinician or technician conducts a brief pre-treatment assessment including suicidal ideation screen, medication review, and device safety check. The patient is positioned in a dedicated TMS suite or outpatient procedural room; the provider programs the TMS device parameters, confirms coil placement over the targeted dorsolateral prefrontal cortex, and delivers a session of repetitive stimulation while monitoring tolerance and side effects. Post-session, the patient is observed briefly for headache or discomfort, counseled on expected transient adverse effects, and scheduled for the next session. Clinical documentation includes indication, session number, device settings, coil positioning, patient tolerance, and any complications. Billing for subsequent delivery and management of TMS per session is reported with 90868.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a medically necessary E/M is performed and documented on the same day as a TMS session and is above and beyond routine pre-procedure checks.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry & Neurology - Psychiatry	Psychiatrists commonly order, oversee, and interpret TMS treatment plans.
`2084N0400X`	Psychiatry & Neurology - Neurology	Neurologists may perform or supervise TMS when treating neuropsychiatric conditions.
`363L00000X`	Behavioral Health & Social Service Providers - Other Behavioral Health Specialties	Behavioral health physicians or advanced practice providers involved in TMS delivery and management.
`363LP0800X`	Behavioral Health & Social Service Providers - Psychiatric/Mental Health Nurse Practitioner	Nurse practitioners frequently administer sessions under physician supervision in outpatient clinics.
`207Q00000X`	Physician Assistant	Physician assistants commonly assist with patient assessment and device operation during TMS therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F33.1`	Major depressive disorder, recurrent, moderate	Common indication for TMS when patients have recurrent depressive episodes and inadequate response to pharmacotherapy.
`F32.1`	Major depressive disorder, single episode, moderate	TMS is used for moderate single-episode major depression when other treatments are insufficient.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	TMS is indicated in severe recurrent depression for patients who are partial or nonresponders to medications.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when specific episode severity is not otherwise specified but major depression is the treatment target for TMS.
`F33.9`	Major depressive disorder, recurrent, unspecified	Used when recurrent depression is documented but specifics are not coded; still clinically relevant for TMS treatment decisions.
`G47.00`	Insomnia, unspecified	Comorbid insomnia frequently co-occurs with depression and may be documented in the treatment plan accompanying TMS sessions.
`F43.21`	Adjustment disorder with depressed mood	In selected cases, neuromodulation may be considered when other therapies have failed and clinical judgment supports its use.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90867`	Therapeutic repetitive transcranial magnetic stimulation; initial, including cortical mapping, motor threshold determination, and first treatment session	Performed before a course of TMS to establish motor threshold and initial treatment parameters; typically billed once at the start of a full treatment series.
`90869`	Therapeutic repetitive transcranial magnetic stimulation; subsequent motor threshold re-determination	Used when motor threshold must be re-determined during a course of TMS, for example after device parameter changes or extended intervals between sessions.
`96127`	Brief emotional/behavioral assessment (e.g., depression screening)	Used for brief validated screening or symptom rating performed in conjunction with TMS sessions to document response trajectories.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used when a separate, medically necessary E/M visit is performed and documented on the same day as a TMS session (would require appropriate modifier, e.g., `25`).
`90901`	Biofeedback training, per session of 15 minutes	Occasionally performed in multimodal behavioral programs; listed as an adjunctive neuromodulation-related therapy when clinically indicated.

OpenPayer

Summary & Overview

CPT 90868: Transcranial Magnetic Stimulation, Subsequent Session