TMS Billing 90867/90868/90869 — 2026 Complete Guide
Transcranial Magnetic Stimulation (TMS) billing has some of the most rigid prior-auth windows in behavioral health. A 36-session TMS PA typically has a 12-week window; miss the window and you re-authorize from scratch.
The 3 TMS CPT Codes
- 90867 — Initial TMS treatment (motor threshold determination + first session) — one per course
- 90868 — Subsequent TMS treatment (sessions 2-36) — daily during acute phase
- 90869 — Motor threshold re-mapping (only when clinically indicated) — usually zero-to-one per course
2026 Denial Patterns for TMS Clinics
- 36-session auth window slippage — PA approved but sessions delivered outside the 12-week window
- Psychiatrist attestation gaps — some payers require MD attestation per session (not just supervision)
- 90867 vs 90868 misapplication — clinics billing 90867 more than once per course
- MHPAEA parity denials on TMS coverage — commercial payers denying medically necessary TMS
Fix — TMS Recovery Loop
Weekly PA window monitoring + auto-alert when clinics near expiration. Per-payer TMS credentialing library. MHPAEA parity appeals on coverage denials.
Case Study
12-site BH $70M rev. 90-day cash recovery: $1.04M. TMS-specific recovery patterns included. Full case study.
Free 30-day TMS audit · Pricing 4-8%
– KD, Revenant Care