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Current Procedural Terminology (CPT)1
Several CPT codes may be used for reporting the various services related to the
delivery of TMS therapy. For the NeuroStar TMS Therapy procedure itself, the AMA
created Category III CPT codes to report this service. These codes are effective
for dates of service on or after January 1, 2007. The Category III codes were released
by the AMA and have been available for use effective July 2006. These codes are
Category III codes as they were awarded prior to Food and Drug Administration (FDA)
approval of NeuroStar TMS Therapy. Under current AMA CPT coding development procedures,
Category I codes are not available prior to FDA approval of a new procedure.
Category III CPT codes are temporary codes that allow data collection for emerging
technologies, procedures and services. It is important for healthcare providers
to report appropriate codes to support accurate tracking of data and provide evidence
of utilization of these technologies. Guidance from the AMA indicates that “if a
Category III code is available, this code must be reported by healthcare providers
in place of an unlisted CPT Category I procedure code.” However, it is recommended
you check with specific payers to determine their coding policies. It is always
the provider’s responsibility to determine and submit appropriate codes for the
services rendered.
Some payers, including Medicare, may not cover or separately reimburse services
reported with Category III CPT codes. However, other payers may choose to recognize
a Category III CPT code for coverage and payment. The AMA created the following
Category III CPT codes for NeuroStar TMS therapy:2
Table 3. NeuroStar TMS Therapy Category III CPT Codes
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0160T
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Therapeutic repetitive transcranial magnetic stimulation treatment planning
Pre-treatment determination of optimal magnetic field strength via titration, treatment
location determination and stimulation parameter and protocol programming in the
therapeutic use of high power, focal magnetic pulses for the direct, noninvasive
modulation of cortical neurons.
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0161T
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Therapeutic repetitive transcranial magnetic stimulation treatment delivery and
management, per session
Treatment session using high power, focal magnetic pulses for the direct, noninvasive
modulation of cortical neurons. Clinical evaluation, safety monitoring and treatment
parameter review in the therapeutic use of high power, focal magnetic pulses for
the direct noninvasive modulation of cortical neurons.
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Code Usage: The AMA created CPT code 0160T to report treatment planning services
during the initial patient visit. This includes determining the patient's cortical
neuron excitability or motor threshold (MT) value, determining and storing the cortical
landmark coordinates corresponding to the location were MT was determined, determining
and storing the treatment location coordinates, and selecting and storing treatment
parameters for a given treatment protocol. CPT code 0161T was created to report
services for each session when treatment is delivered and patient management services
are provided. Thus, for the initial visit (day one of TMS Therapy) when a treatment
planning session is completed and a treatment delivery session is completed, both
0160T and 0161T should be reported. On subsequent treatment days, when only treatment
delivery and management is provided, only 0161T would be reported. Example: If the
course of TMS Therapy for a given patient consisted of 26 treatments, 0160T would
be reported once and 0161T would be reported 26 times for that patient for this
course of therapy. If MT must be re-determined during the course of therapy, code
0160T may be used to identify that service.
Again, the AMA indicates that “if a Category III code is available, this code must
be reported by healthcare providers in place of an unlisted CPT Category I procedure
code.”2 Nonetheless, if directed by a payer not to use Category III CPT
codes 0160T and 0161T or under other circumstances in which a provider performs
services not described by a more specific code, the provider may report an unlisted
or miscellaneous code such as the following:1
Table 4. Miscellaneous Code
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90899
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Unlisted psychiatric service or procedure
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Payers typically manually review unlisted codes to confirm coverage and reimbursement
rates for the services provided. To complete this review, the provider may need
to submit documentation to the payer describing the services provided, the technology
used, and the reasoning behind the treatment (e.g., letter of medical necessity).
The AMA notes, “Pertinent information should include an adequate definition or description
of the nature, extent, and need for the procedure and the time, effort, and equipment
necessary to provide the service. Additional items may include complexity of symptoms,
final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures,
concurrent problems, and follow-up care.”3 Providers should contact individual
payers directly to verify the appropriate code(s) for reporting NeuroStar TMS Therapy
and claim documentation requirements.
View the complete Billing Guide
References:
- Current Procedural Terminology (CPT® 2008), Professional Edition,
American Medical Association, 2007, 449.
- Current Procedural Terminology (CPT® 2008), Professional Edition,
American Medical Association, 2007.
- Current Procedural Terminology (CPT® 2008), Professional Edition,
American Medical Association, 2007, xvi
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NeuroStar TMS Therapy may be right for your patients suffering from major depression. Refer them here.
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