What is CPT code 90868?
CPT code 90868 represents the subsequent delivery and management of transcranial magnetic stimulation (TMS) treatment following the initial setup session. This code specifically covers therapeutic repetitive transcranial magnetic stimulation sessions that occur after the initial motor threshold determination and cortical mapping have been completed.
This is part of a series of CPT codes established by the American Medical Association to document and bill for repetitive transcranial magnetic stimulation procedures properly. Unlike the initial TMS setup codes, this subsequent delivery and management code focuses on the ongoing treatment course for patients receiving TMS treatment.
Transcranial magnetic stimulation is a non-invasive neurological treatment that uses magnetic fields to stimulate specific brain regions. The treatment typically involves multiple sessions over several weeks. TMS treatment is primarily utilized for major depressive disorder when other therapeutic interventions have proven insufficient. The treatment response varies among patients, requiring careful monitoring and documentation throughout the treatment course.
Documentation requirements
Proper documentation for CPT code 90868 requires comprehensive record-keeping that demonstrates medical necessity and tracks treatment response throughout the subsequent delivery process.
Clinical documentation must include the date, duration, and specific parameters of each TMS treatment session. This includes:
- Magnetic field intensity
- Pulse frequency
- Total number of pulses delivered
- Patient tolerance during treatment
Treatment response monitoring is also a critical component of documentation. Records should track depressive symptoms using standardized assessment tools, noting any changes in symptom severity, functional improvement, or adverse effects. This documentation supports the ongoing medical necessity of continued treatment and helps guide maintenance therapy decisions when applicable.
The treating physician maintains sole responsibility for ensuring accurate documentation meets regulatory requirements.
Billing guidelines
Most payers, including Medicare and Medicaid Services, establish limits on the number of TMS treatment sessions covered within a specific timeframe. A typical treatment course may include 20-36 sessions over 6-9 weeks, though individual patient needs may vary based on treatment response and clinical factors.
The 90868 CPT code can be reported once per treatment session, with each session representing a separate billable encounter. Providers should verify payer-specific policies regarding session frequency, as some insurers may require documentation of treatment response before approving additional sessions beyond standard protocols.
Other relevant codes
- CPT Code 90867: Therapeutic repetitive transcranial magnetic stimulation treatment; initial, including cortical mapping motor threshold determination, delivery and management per session
- CPT Code 90869: Therapeutic repetitive transcranial magnetic stimulation treatment; subsequent motor threshold re-determination with delivery and management per session
Frequently asked questions
No, CPT code 90868 is not time-based; it is reported per session of therapeutic repetitive transcranial magnetic stimulation (rTMS) delivery and management. Each session typically lasts about 20 to 30 minutes, but the code descriptor specifies billing "per session" rather than by exact time increment.
Yes, licensed psychologists who are trained and qualified to administer rTMS therapy can bill CPT code 90868. Other qualified providers include psychiatrists, neurologists, and advanced practice nurses with appropriate training in TMS procedures.
CPT 90868 can be billed for each rTMS treatment session delivered, typically multiple times over several weeks as part of a treatment course. However, billing guidelines and payer policies may limit frequency.
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