CPT 90867 falls under the psychiatry section of the Current Procedural Terminology (CPT) code set. It is arguably the most important code in the TMS series.
The Official Description of CPT code 90867 is “Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.”
In simple terms, this code pays for the very first session of a TMS treatment course. It is not just a treatment session. It involves the extensive setup work the physician must perform to calibrate the machine for the specific patient.
In this guide, we’ll break down what CPT 90867 specifically covers, proper billing practices, payer documentation requirements, common errors to avoid, and practical tips to help providers maximize reimbursement while maintaining compliance.
Services Included in CPT 90867
CPT 90867 represents the comprehensive first step in TMS therapy. It covers all essential components needed to safely initiate treatment.
- Initial patient evaluation and setup for TMS therapy.
- Motor threshold determination (measuring the device intensity needed to stimulate a motor response).
- First delivery and management of TMS treatment.
- Includes cortical mapping and treatment planning as part of the initial session.
This code is billed once per complete course of treatment because it covers the initial, patient-specific setup and calibration.
Why is the 90867 CPT Code Important?
TMS therapy is gaining acceptance across mental health providers and payers due to its effectiveness. CPT code 90867 allows providers to bill separately for the initial setup, which requires more time and technical work compared to routine sessions. Billing 90867 correctly ensures:
- Proper reimbursement for the initial work.
- Clear documentation of patient-specific motor threshold evaluation.
- Compliance with payer rules differentiating first and subsequent sessions.
Who Can Bill CPT 90867?
Billing for the professional component (the mapping and threshold work) of 90867 is restricted to qualified healthcare providers with specialized TMS training. This generally includes:
- Psychiatrists (MD/DO)
- Neurologists (MD/DO)
- Psychiatric nurse practitioners (NPs) and physician assistants (PAs) with TMS training, operating under appropriate supervision rules.
Important Note: Due to the clinical nature of the procedure, the initial mapping and threshold determination must be performed or directly supervised by a physician or other qualified non-physician practitioner (NPP) according to payer policies. Billing by untrained or uncredentialed staff can lead to claim denials or legal issues.
CPT Code 90867 Versus Related Codes
90867 is for the initial TMS session with motor mapping, while related codes cover follow-up treatments and adjustments. Knowing the differences helps prevent billing errors and secure proper reimbursement.
- CPT 90867: The initial session, including mapping, threshold determination, and the first treatment.
- CPT 90868: Billed for subsequent, routine daily TMS treatment sessions after the initial session.
- CPT 90869: Billed for a subsequent re-mapping of the motor cortex during treatment, if required.
Crucial Billing Rule: 90867 should only be billed once per course of treatment. A new course of treatment is usually allowed if a patient experiences a new, distinct episode of depression following a period of remission, provided medical necessity criteria are met.
How to Properly Document CPT 90867 Sessions
Documentation is the foundation for clean claims and audits. Key points to document for CPT 90867:
- Patient evaluation: Background, diagnosis, and treatment plan.
- Motor threshold testing: Exact procedure and numeric results.
- Treatment plan: Magnetic coil positioning and stimulation parameters.
- Patient consent: Records indicate that informed consent for TMS was obtained.
- Observation and management: Patient’s response and any adjustments made.
Good documentation not only supports reimbursement but also proves medical necessity in audits.
Reimbursement Rates for CPT Code 90867
Reimbursement rates for CPT code 90867 can vary based on the payer, geographic location, and provider credentials. Below are some typical rates observed in 2025:
- Medicare: $200-$300
- BCBS PPO: $433.87
- BCBS HMO: $390.48
- BCBS (Pathway): $344.49
- Aetna: $358.54
- Tricare East: $2,797.87
- UHC: $250.00
- Cigna: $240.00
- Humana: $255.62
Please note that these are average figures and actual reimbursement rates may differ.
Common Mistakes to Avoid When Billing CPT 90867
While 90867 is straightforward in its purpose, administrative errors are common. Here are the most frequent mistakes that lead to denials:
- Billing 90867 Too Frequently: Do not bill this code for every visit. It must be strictly limited to the first session of a new course of treatment.
- Missing Prior Authorization: Nearly all payers require prior authorization for TMS therapy. The authorization must be secured before the first treatment date.
- Using Mutually Exclusive Codes: Never bill CPT 90867 and 90868 (subsequent treatment) for the same patient on the same day.
- Inadequate Clinical Documentation: Failing to clearly document the numeric motor threshold and the required number of failed prior treatment trials is the number one reason for audits and recoupments.
- Incorrect Supervision: If the mapping was performed by an unqualified staff member without the required direct supervision, the claim will be denied upon review.
Tips to Maximize Reimbursement for CPT 90867
Proper billing and documentation are critical for securing timely reimbursement when using CPT 90867 (Initial TMS treatment with motor threshold determination). Here are key strategies to help you avoid revenue loss:
- Leverage EHR Systems: Use electronic health record systems that integrate clinical and billing documentation to reduce errors and improve claim accuracy.
- Train Staff Regularly: Provide ongoing training for therapists and billing staff on CPT code updates and payer-specific rules to ensure compliance.
- Conduct Routine Billing Audits: Audit claims for completeness and accuracy before submission to minimize denials and rework.
- Appeal Denials with Strong Documentation: If a claim is denied, submit an appeal with comprehensive medical records showing the patient’s need for TMS and ineligibility for other treatments.
- Track Denial and Payment Trends: Monitor patterns by payer to identify recurring issues and adjust processes for improved success rates.
- Stay Updated on Medicare Fee Schedules: Regularly check for regional Medicare updates to align billing with current reimbursement rates.
Conclusion
CPT 90867 is essential for any practice offering TMS. This code is the foundation of a successful TMS billing process, allowing you to correctly capture the significant initial time and expertise required for patient setup.
If you are looking for a trusted partner to handle your TMS therapy billing efficiently and accurately, FC Billing is here. We offer expert TMS billing services, helping practices achieve 100% claim payment, reduce denials, and streamline revenue cycles.
