Wiki TMS Medical Necessity Codes

[tbattle511]

Hello All,

I need to know the medical necessity codes for CPT's 90868, 90869 and 90867 ? Can anyone help me please ?

Thank you.

 

[LMBENHOFF]

Here is the Link for UHC payer policy for TMS. Most payers share this protocol to follow when providing TMS, including prior failed therapies.

https://www.uhcprovider.com/content/dam/.../transcranial-magnetic-stimulation.pdf

The only two covered diagnosis are:
Major Depressive Disorder - Single Episode, Severe, Without psychotic features F32.2
Major Depressive Disorder - Recurrent Episode, Severe, Without psychotic features F33.2

I hope that helps!