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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, Category I CPT Codes are available effective January 1, 2011. The American Medical Association (AMA) has elevated the current Category III “T” Codes (0160T and 0161T) for TMS to the following Category I CPT Codes.2
Table 3. NeuroStar TMS Therapy Category I CPT Codes
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90867
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Therapeutic repetitive transcranial magnetic stimulation treatment; planning
(Report only once per course of treatment.)
(Do not report in conjunction with 95928, 95929.)
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90868
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Therapeutic repetitive transcranial magnetic stimulation treatment; delivery and management, per session
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Code Usage: The AMA created CPT code 90867 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 90868 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
90867 and 90868 should be reported. On subsequent treatment days, when only treatment
delivery and management is provided, only 90868 would be reported. Example: If the
course of TMS Therapy for a given patient consisted of 26 treatments, 90867 would
be reported once and 90868 would be reported 26 times for that patient for this
course of therapy.
The Federal Register issued on November 2, 2010 provides the AMA’s decision to elevate the TMS codes to Category I status. It states that the CPT I codes for TMS for CY 2011 will not include physician work and practice expense RVUs. As a result, the TMS codes will be contractor priced.
Payers will typically manually review codes without Relative Value Units (RVUs) 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. ”4 Providers should contact individual payers directly to verify the appropriate code(s) for reporting NeuroStar TMS Therapy and claim documentation requirements.
View the Reference Coding Guide for Coding of NeuroStar TMS Therapy
If operating in a hospital, click here to view the Hospital Coding Reference Guide.
References:
- Current Procedural Terminology (CPT® 2011), Professional Edition,
American Medical Association, 2010. CPT is a Registered Trademark of the American Medical Association.
- Current Procedural Terminology (CPT® 2011), Professional Edition,
American Medical Association, 2010. 457
- Federal Register, November 2, 2010, Vol. 75, No. 211 (557).
- Current Procedural Terminology (CPT® 2011), Professional Edition,
American Medical Association, 2010, xvi
Please Note: The information contained provided is for educational purposes only. It is intended to assist providers in accurately obtaining reimbursement for healthcare services. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that you consult the specific payer with regard to local reimbursement policies. The information, including all CPT® & HCPCS billing codes, contained in this guide represents no statement, promise or guarantee by Neuronetics concerning levels of reimbursement, payment, or charge. It is always the provider’s responsibility to determine and submit appropriate codes for the services rendered.
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