Submitting Transcranial Magnetic Stimulation (TMS) Claims

illustration of behavioral health concepts

Transcranial Magnetic Stimulation (TMS) is a good option for the treatment of depression, especially in cases of Resistant Major Depressive Disorder. However, submitting medical claims for TMS therapy is sometimes a challenging task for psychiatric practices and other medical centers.

A facility's time is often better spent attracting new patients and monitoring the quality of delivered healthcare services. We have found that having to deal with complicated insurance policies and regulatory requirements that often surround TMS, robs a practice of valuable time and resources.

This is why TMS billing is one of the specialties that we focus on at RevUp Billing. The goal of nearly all medical practices is to maintain a healthy revenue cycle and stable cash flow. This is also a central goal at RevUp Billing. We actively work with practices and clinics in order to maximize their reimbursements from the various insurance payers.

Revenue margins are nearly always tight, with many behavioral health practitioners agreeing that reimbursement rates are already too low. Especially when one considers the valuable mental health services that behavioral health specialties provide to their patients and community.

It is only natural that facilities and practices want to capture all of the revenue that has been rightly earned by their hard work. We understand that every claim is important for a behavioral health practice's financial bottom line. However, TMS therapy can sometimes create complicated medical claims that insurance payers might initially reject or deny.

Best TMS Reimbursement Practices:

The behavioral health revenue cycle management model has changed over the years. Initially, some insurance payers were hesitant to provide financial reimbursement for some mental health services, including TMS treatments. However, times have changed, but mental health practitioners need to document the delivery of TMS therapy and any related treatments.

TMS providers should follow established billing practices such as:

  • Verify that the TMS therapy is considered medically necessary before the administering of treatment.
  • When needed, all medical insurance claims for TMS treatments should have prior authorization numbers.
  • Always provide consistent and clear billing descriptions for any additional services.
  • Submit all TMS claims to insurance payers as quickly as possible.

By consistently following these guidelines, many of the issues that arise when submitting TMS claims are avoided.

Additional therapies and medication management are sometimes part of the TMS treatment approach. Psychiatry billing departments need to fully understand how to integrate these treatments into the claims process without triggering any denials or rejections. Otherwise, a correctly organized claim that has been pre-authorized, may get rejected by an insurance payer.

The Centers For Medicare & Medicaid Services (CMS) provides some information about how to bill for TMS therapy, which is sometimes referred to as Repetitive Transcranial Magnetic Stimulation (rTMS). The CMS states that three CPT codes are generally used for the billing of TMS treatments, which are 90867, 90868 and 90869.

There are also a few modifiers that are regularly used in the TMS billing process. In general, modifiers are used to indicate that a delivered treatment or service has been modified due to a specific reason. However, the procedure's medical code has not changed.

The most common modifiers that are used in TMS therapy claims are #25 and #59. Other common modifiers include:

  • # 24 - Unrelated E/M service by the same doctor during a post-operative period.
  • # 26 - Technical component (TC). There is both a professional and technical component to this procedure.
  • # 27 - Patient has multiple visits on the same day, by the same or different physician.
  • # 51 - Multiple procedures by the same provider at the same session.
  • # 76 - Repeated by the same medical provider on the same day, but separate sessions (excluding surgical codes).

All TMS procedures need to be well-documented so that insurance providers can review notes and authorization requests. As a reminder, healthcare plans will only provide coverage for Transcranial Magnetic Stimulation if the procedure is deemed medically necessary. Also, other medical treatment options have all been exhausted.

Additional complexity is added due to the fact that every healthcare insurance plan will have different policies and procedures surrounding the billing of TMS treatments.

An experienced and knowledgeable billing staff will understand the requirements of billing for TMS therapy. When issues do appear, they are quick to respond and take the appropriate actions. This organized approach is the best way to catch mistakes and minimize any denied or rejected TMS claims.

Who We Are:

RevUp Billing prides itself on delivering experienced and professional billing and credentialing services. Their billing and credentialing specialists offer revenue cycle management (RCM) solutions that streamline a medical practice’s billing, coding and claims processing tasks. They also offer reliable billing and software services to I-DD Waiver provider agencies.

If you have additional questions about billing for TMS treatments or other general behavioral & mental health billing questions - contact us.

RevUp Billing provides trusted and experienced billing services for healthcare practitioners. Like, subscribe and follow RevUp Billing on Facebook, Instagram, LinkedIn & Twitter.

Updated from original article published on October 12, 2021

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