Transcranial Magnetic Stimulation (TMS) is an amazing breakthrough 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.
This is why TMS billing is one of the revenue cycle specialties at Advanced Billing & Consulting Services (ABCS). We realize that having to deal with complicated insurance policies and regulatory requirements that often surround TMS, robs a practice of valuable time and resources. A facilities time is often better spent attracting new patients and monitoring the quality of delivered healthcare services.
The goal for nearly all medical practices is to maintain a healthy revenue cycle and stable cash flow. This is the primary mission of ABCS, as we actively work with practices in order to maximize their reimbursements from the various insurance payers. Many behavioral health practitioners would agree 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.
With this in mind, 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 billing 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 well-document the delivery of TMS therapy and any related treatments.
Established billing practices such as:
- Make sure that the TMS therapy is considered medically necessary before the treatment.
- When needed, all claims for TMS treatments have prior authorization numbers.
- Consistent and clear billing descriptions for any additional services.
- Submit 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. 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 claims 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 as medically necessary. Also, other medical treatment options have all been exhausted.
Additional complexity is added do 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.
ABCS RCM (Advanced Billing & Consulting Services) delivers experienced billing and marketing services for healthcare practitioners as well as Ohio Waiver Provider Agencies that provides support for individuals with developmental disabilities.
As a company with a long history in Ohio, ABCS has a proven track record of results. We provide services and tools that optimize a medical practice or waiver provider agency’s billing processes. As an Ohio-based company, we are familiar with the unique needs and challenges facing waiver provider agencies.
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