Specialized TMS Billing. Stronger Revenue. Fewer Denials.
Simplify TMS Billing. Maximize Reimbursements. Focus on Patient Care.
Practolytics provides specialized TMS billing services designed for transcranial magnetic stimulation clinics. From insurance eligibility and prior authorizations to CPT coding, claims submission, denial management, and A/R follow-ups, our expert team helps streamline your revenue cycle, reduce billing complexities, and improve reimbursement outcomes.
TMS Billing Services for Transcranial Magnetic Stimulation Clinics
TMS clinics need billing procedures that account for the payer’s coverage policy, proper documentation, treatment authorization, and repeat visits. Unlike regular office visits, TMS treatment necessitates close coordination between documentation and billing.
TMS billing services ensure all of these requirements can be met in your clinic. We have highly specialized staff to deal with each part of the billing process, including eligibility, coding, submitting claims, managing denials, and reconciling payments.
What We Handle
- Prior to treatment, check your coverage and benefits.
- Document authorization approvals and approved sessions.
- Code CPTs based on services provided.
- Monitor denials, collection, and accounts receivable.
Why TMS Billing Is Different From Standard Psychiatry Billing
TMS billing has unique elements related to TMS treatment that are not typically found in standard psychiatric insurance claims. In order for the payer to cover these claims, they will want to look at certain factors such as diagnosis, treatment history, medical necessity, limits on authorizations, how often sessions are provided, and progress reports.
A specialist TMS billing company such as Practolytics recognizes the role that clinical documentation plays for the services billed. Some important information to know when coding is:
This makes the transcranial magnetic stimulation billing more specialized than psychiatry billing services.
Important Information When Coding
- Medical necessity: Ensure that documentation supports the diagnosis, treatment history, and reason for treatment.
- Authorization: Be aware of what is required for authorization, any restrictions on treatment, and when it needs to be renewed.
- Sessions: Balance the number of sessions provided against authorized sessions.
- Clinical procedure records: Keep records of cortical mapping and motor threshold testing if applicable.
- Payer policies: Check the relevant Medicare LCD for TMS or the commercial insurance company policy.
Our End-to-End TMS Billing Services
Our scope of service will include administration and revenue processes for managing TMS claims. Depending on the service you agree to, we can offer TMS medical billing services to help your clinics by supporting them from the point of financial clearance to payment reconciliation.
Services may include:
Eligibility and benefits confirmation
Confirming that the patient is covered, has appropriate co-pay/coinsurance, and has any treatment requirements.
TMS Authorizations
Creating authorizations, tracking how many sessions have been authorized, and any requirements for concurrent authorizations.
Coding and Charging
Ensure that services have been correctly coded in line with the information given and the coding criteria.
Claims
Ensure claims are reviewed and raised using approved billing channels.
Denials
Research payer responses, resolve any errors that can be supported, and manage the appeal process.
A/R
Monitor claims to ensure they are followed up on, and any discrepancy in payments is identified.
Our TMS billing and coding services are designed to be used in conjunction with the clinic's clinical team. The clinicians will maintain accurate records of the care provided and the decisions made, whilst our billing process ensures that claims are correctly submitted.
TMS CPT Codes We Bill (90867, 90868, 90869)
Correct coding is very important when billing for TMS therapy. The most commonly used codes are CPT codes that indicate various stages of repetitive TMS therapy. Therefore, it is vital that you choose the correct code for the service you provided and have documented it.
| CPT code | General service description |
|---|---|
| 90867 | Initial treatment, including planning, cortical mapping, motor threshold determination, delivery, and management. |
| 90868 | Subsequent treatment delivery and management, per session. |
| 90869 | Subsequent major motor threshold redetermination with delivery and management. |
Do not use these codes interchangeably. There are many articles on coding for Medicare billing, and it is important to know how to correctly utilize and document your codes. Each insurance company will have different requirements, so it’s important to look at the CMS guidelines. There are specific guidelines for codes 90867 and 90869. Clinics need to make sure they are using the right coding policies.
Before You Submit
- Verify dates and services.
- Ensure documents match codes.
- Check any relevant payer edits and frequency.
Top Reasons TMS Claims Get Denied (and How We Prevent Them)
Claims denied within TMS can be due to lack of authorization, incomplete clinical records, coding errors, and issues with eligibility. They may also be due to services exceeding the agreed treatment limits. If this is a recurring issue, then it may indicate a gap in the clinic's processes.
Structured review can help uncover common issues:
Authorization issues
Have you documented when the patient was approved, how many sessions they were approved for, and if reauthorization was needed?
Medical Necessity
Is your documentation supporting the clinical guidelines of the payer?
Coding Issues
Are your CPT codes accurate?
Incorrect diagnosis coding
Check that the ICD-10 coding is evidenced and covered by policy.
Incorrect eligibility
Check that the patient is actively covered and has benefits.
Late submission and chasing
Monitor submission dates and outstanding claims.
Pricing Structure of TMS Billing
TMS revenue cycle management pricing will depend upon the number of claims, services provided, types of payers, the level of authorization work, and the existing state of your accounts receivable. Some companies charge a percentage rate, a flat fee, or a combination of a percentage and flat fee.
Ensure that the transparent pricing details everything you will be charged for ahead of onboarding. Don’t just look at the percentage—a low percentage might mean you will miss out on tasks that your clinic will still need to handle.
Ask for a detailed pricing structure
- What percentage are they charging?
- Do they include services like eligibility, authorizations, coding, and denial follow-up?
- Are there extra charges for things like credentialing, setup fees, or aged A/R?
- Length of contract, cancellation policy, and minimum guarantees?
- Reporting intervals and services provided under the agreement.
How Onboarding Works: From Kickoff to First Clean Claim
A clear onboarding process will help ensure that your clinical notes, invoicing, payers, and access to the system are set up correctly. The time it takes will depend on the clinic’s current processes, software, and whether they have any outstanding billing issues with payers.
Usually, the onboarding process will include:
Kick-off and assessment
Number of claims, types of payers, current number of denials, and A/R.
Credentialing
Identify issues with provider enrollment/insurance company involvement.
Access
Ensure you have approval to gain access to the EHR and billing system.
Process documentation
For charge entry, authorization tracking, coding, and claims submission
Claim Review
All information is complete and specific for each payer.
Performance Review
Clean Claim Rate, Denials & A/R Days.
To ensure clean claims are being generated, you need to have full documentation, accurate information, and know what is required by the payers. Having good communication between the clinic and billing team will help identify any setup issues.
What TMS Practices Say About Practolytics
When choosing a billing partner, you want to be confident that they can communicate, report, and understand TMS processes. Practices need to be able to determine whether they can provide the right support for the practice’s mix of payers, authorizations, coding, and current systems.
When evaluating Practolytics, clinics should look for clear answers about
- Experience with TMS and interventional psychiatry billing.
- Support billing and payer documentation for treatment-resistant depression (TRD).
- Experience with repetitive TMS (rTMS) processes.
- Report on denied claims, collections, and A/R.
- Collaborate with the billing team and clinical staff.
TMS Billing FAQs
What are TMS billing services?
TMS Billing Services help ensure your clinic can easily handle all aspects of TMS billing, including (but not limited to) verifying benefits, obtaining prior authorization, coding, claim submissions, remittance, and denial and A/R follow-up.
Which CPT codes are used for TMS billing?
The most commonly used codes are 90867 (first therapy including evaluation and mapping), 90868 (therapy), and 90869 (re-evaluation of major motor threshold and therapy). Be sure to know which codes your payers will use.
Does TMS require prior authorization?
Many commercial plans and some public insurance will require pre-authorization. Check what the patient's plan requires, what medical necessity is required, how many sessions are approved, and what requirements are there to renew.
How much do your TMS billing services cost?
Pricing can be based on the number of claims, types of payers, and what work is involved. The provider may charge an amount based on a percentage or a fixed charge. Request a breakdown of all costs and charges in writing.
Why do TMS claims get denied?
Common reasons for claims being denied include missing authorizations, incomplete medical necessity, CPT, diagnosis, and coding errors, ineligibility, maximum visits exceeded, and late filing. It can be helpful to look at trends in this area to see what issues you are having.
Which insurance plans cover TMS therapy?
This will depend on the insurance company, the scheme, the diagnosis, whether they meet the clinical criteria, and if they are within your network. It can also depend on which LCD is applicable and billing guidelines. Please check what benefits apply to each individual patient.
Can you bill both TMS and Spravato?
TMS and Spravato (esketamine) will be treated differently, documented differently, and coded differently, and there are a variety of payer requirements. However, both can be supported by a billing team who can cover all aspects of the service. The claims need to be accurate and match the payers' requirements.
Do I need to change my EHR or billing software?
Not necessarily. It is important to ensure your billing team can work within your existing EHR/practice management system. You want to ensure that they have all the correct compatibility, permissions, access to data, and process requirements.
How fast do you submit claims?
The submission of documentation will be dictated by the availability of the documentation, coding, internal processes, and the agreed process. A clear schedule should be set for the submission of documentation, and any delays due to lack of documentation and approvals should be tracked.
Can you help with old denials and aged A/R?
Whether you need an individual service or ongoing service around aged A/R and reactivation, ask about: Prioritization of claims and how you'll make sure they are submitted within time frames. How will you ensure appeal deadlines are met?
Specialized TMS Billing. Stronger Revenue. Fewer Denials.
Practolytics provides specialized TMS billing services designed for transcranial magnetic stimulation clinics. From insurance eligibility and prior authorizations to CPT coding, claims submission, denial management, and A/R follow-ups, our expert team helps streamline your revenue cycle, reduce billing complexities, and improve reimbursement outcomes.