Get the full course approved and every session paid. TMS therapy medical billing and coding services built around authorizations, session counts, and payer coverage rules.
Nevada Medical Billing provides TMS billing services for transcranial magnetic stimulation clinics, psychiatric practices, and interventional mental health centers across Nevada. We handle what decides whether a TMS course gets paid: coverage criteria, prior authorization for the full course, session tracking against approved units, 90867, 90868, and 90869 coding, motor threshold documentation, and denial appeals. We bill Medicare, Medicare Advantage, Nevada Medicaid and its five managed care plans, TRICARE, and commercial insurers.
Share a few details and a TMS billing specialist will review your authorizations, session counts, and denials with you.
TMS billing is different because you aren't billing a visit, you're billing a course. One patient becomes 30 to 40 claims over six to nine weeks, all riding on a single authorization that a payer approved for a set number of sessions. If the approval, the session count, or the motor threshold documentation slips, every remaining session in the course is at risk.
Payers also treat TMS as a high-review service. They want proof of treatment-resistant depression, documented failed medication trials with dose and duration, and validated symptom scores before they approve the first session, and again before any extension or re-treatment.
When a patient misses sessions or needs taper sessions, the course runs longer than the approval. Sessions given after the authorized count or end date are usually denied, and appeals for them rarely succeed.
The most common reason TMS authorizations are denied is a failed-trial history that doesn't list each antidepressant's dose, duration, and outcome. A packet that says "failed multiple medications" isn't enough.
The initial session code with cortical mapping is billed once per course. Billing it again for later mapping sessions triggers denials; re-mapping uses 90869.
Payers can ask for coil location, motor threshold, stimulation parameters, and patient response for each session. Gaps found in an audit lead to recoupments months after payment.
Patients who relapse may qualify for another course, but most payers apply separate re-treatment criteria, such as a documented response to the first course. Re-treatment requests built like new cases get denied.
Many commercial plans route TMS through a behavioral health vendor. Authorizations requested from the medical plan, or claims sent there, are rejected.
A standard TMS course for depression runs daily on weekdays for about six weeks, then tapers, for roughly 36 sessions in total. Here's how that course turns into claims.
90792 or E/M
baseline scores
90867, once
motor threshold
90868 per session
90869 if re-mapped
90868 per session
fewer per week
outcome scores
re-treat criteria
Losing sessions at the end of a course? Get a Free TMS Billing Audit and we'll match your session counts to your authorizations.
Get a Free TMS Billing Audit →| Code | What it covers | How often | What we get right |
|---|---|---|---|
| 90867 | Initial TMS treatment, including cortical mapping, motor threshold determination, delivery, and management | Once per course | Billed only on the first session; not repeated for later mapping |
| 90868 | Subsequent treatment delivery and management, per session | Each session after the first | Count matched to the authorization; one per day |
| 90869 | Subsequent motor threshold re-determination with delivery and management | Only when threshold is re-measured | Documented reason for re-mapping; not billed with 90868 the same day |
| 90792 or 99202–99215 | Psychiatric evaluation before the course, and periodic E/M visits during it | Per payer policy | Separate E/M on a treatment day only when significant and separately documented, with modifier 25 |
| 90833, 90836, 90838 | Psychotherapy add-ons with an E/M | When therapy is separately provided | Time distinct from the TMS session |
Diagnosis coding must support covered indications, most often major depressive disorder, single or recurrent episode, coded to severity (such as F32.2 or F33.2). Unspecified depression codes are a common denial trigger.
Newer TMS techniques with Category III codes are generally not covered by payers; we confirm coverage before treatment.
Most payers, including Medicare, cover TMS for adults with treatment-resistant major depressive disorder when their criteria are met. Nevada's Medicare contractor, Noridian, publishes its criteria in LCD L37086. Commercial and Medicaid plans usually follow similar criteria and add their own authorization forms.
| Typical criterion | What we document |
|---|---|
| Confirmed diagnosis of major depressive disorder, coded to severity | Diagnosis and current episode details |
| Failed antidepressant trials | Each medication with dose, duration, and reason it failed or wasn't tolerated |
| Trial of psychotherapy (required by many plans) | Type, duration, and outcome |
| Validated symptom scores | Baseline PHQ-9, HAM-D, MADRS, or BDI |
| No contraindications | Screening for seizure history and metal implants near the coil |
| Treatment plan | Device, protocol, and planned number of sessions |
| Indication or approach | Typical devices | Coverage outlook |
|---|---|---|
| Treatment-resistant major depression | NeuroStar, BrainsWay Deep TMS, MagVenture, Magstim | Widely covered when criteria are met |
| Obsessive-compulsive disorder (deep TMS) | BrainsWay Deep TMS | Coverage varies by plan; many cover depression only |
| Theta burst protocols (iTBS) | Devices cleared for theta burst | Often covered under the same codes when the device and protocol are FDA-cleared |
| Accelerated TMS (multiple sessions per day) | Specialized protocols such as SAINT | Frequently limited or not covered; verified plan by plan |
| Maintenance TMS | Any | Usually not covered without strong criteria |
We verify the device, indication, and protocol against each payer's policy before the first session, so a course is never started on a service the plan won't pay for.
Our TMS billing services cover the full course, from the first benefits check to the last taper session. Choose complete revenue cycle management for your TMS program or the services you need.
We confirm TMS coverage, carve-out vendor, covered indications, session limits, copays, deductibles, and whether the plan accepts your device and protocol. Eligibility Verification
We build the medical necessity packet: diagnosis coded to severity, each failed antidepressant with dose, duration, and outcome, psychotherapy history, baseline scores, and treatment plan. We prepare peer-to-peer reviews for your psychiatrist when payers request them. Prior Authorization
Every approved session is tracked against the authorization's count and end date. You're alerted before a course outruns its approval, so extensions are filed in time.
We bill 90867 once, 90868 per session, and 90869 only when threshold is re-measured, and check each claim against session notes for coil location, motor threshold, and parameters.
Claims are scrubbed for frequency rules, authorization numbers, diagnosis specificity, and payer edits, then submitted within 48 hours.
We appeal medical necessity, session-limit, and frequency denials with treatment history and session documentation, and use mental health parity rules when coverage limits are stricter than for medical care. Denial Management
We post payments daily and compare each session's payment to your contracted rate. Payment Posting
We work every open TMS claim, starting with sessions closest to timely filing limits. AR Follow-Up
When a patient relapses or needs more sessions, we build the request around the payer's re-treatment criteria, including documented response to the prior course.
Opening a TMS clinic or adding TMS to a psychiatry practice? We handle payer enrollment, coverage research by device and indication, intake checklists that capture what authorizations need, and billing setup before your first patient.
Session count vs authorization review for active patients
Failed-trial documentation check on recent denials
90867, 90868, and 90869 frequency audit
We respond within 1 business day. No obligation.
| Denial cause | How we resolve it |
|---|---|
| Not enough failed medication trials documented | Rebuild the packet with dose, duration, and outcome for each trial and appeal |
| Sessions past the authorized count or date | Request an extension or retro-authorization where allowed; tighten tracking |
| 90867 billed more than once | Correct to 90868 or 90869 and resubmit |
| 90868 and 90869 on the same day | Keep the correct single code and resubmit |
| Unspecified depression diagnosis | Recode to the documented severity and episode |
| Indication or protocol not covered | Appeal with clinical evidence, or confirm patient responsibility before treatment |
| Authorization from the wrong payer (carve-out) | Re-request through the behavioral health vendor |
| Re-treatment denied | Appeal with documented response to the first course and current scores |
| Practice type | What we handle for you |
|---|---|
| Standalone TMS clinics | Full billing, authorizations, and course tracking |
| Psychiatric practices adding TMS | TMS billing alongside medication management claims |
| Interventional psychiatry centers (TMS and Spravato) | Both treatment lines under one billing team |
| Deep TMS and OCD programs | Indication-specific coverage checks before treatment |
| Multi-site TMS groups | Location-level reporting and standardized authorization workflows |
| New TMS clinics | Launch support from payer enrollment to first claim |
| Payer category | Plans |
|---|---|
| Medicare | Noridian Healthcare Solutions (Jurisdiction E), under LCD L37086 |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, and other MA plans |
| Nevada Medicaid | Fee-for-service Nevada Medicaid, with coverage verified before treatment |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare/Optum, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Behavioral health carve-outs | Vendors that manage TMS approvals for commercial plans |
| Military | TRICARE |
We bill from the systems TMS clinics already use, including NeuroStar TrakStar session data, AdvancedMD, Valant, Tebra/Kareo, DrChrono, athenahealth, eClinicalWorks, Osmind, and SimplePractice. No software change needed. EHR Integration
Also offering Spravato? See our Spravato billing services: the same team can manage both treatment lines.
Free TMS billing audit: We review 90 days of TMS claims, authorizations, session counts, and denials.
Secure setup: We sign a BAA and connect to your EHR, TMS system data, clearinghouse, and payer portals.
Payer and policy mapping: We confirm each payer's criteria, carve-out vendor, and session limits, including Noridian's LCD for Medicare patients.
Course inventory: Every active patient's approval, sessions used, and end date go into tracking before go-live.
Go-live: Daily session coding, scrubbing, and submission begin.
Legacy A/R cleanup: We work old TMS claims in parallel so nothing ages out.
Monthly review: KPI report and a call with your dedicated account manager.
These are the performance standards we manage your TMS revenue cycle to, based on industry best practices.
| KPI | What it measures | Best-practice target |
|---|---|---|
| First-pass clean claim rate | TMS claims paid without rework | 95% or higher |
| Denial rate | Claims denied on first submission | Under 5% |
| Days in A/R | Average time from session to payment | Under 35 days |
| Sessions without approval | Sessions given outside an active authorization | Zero, with course tracking |
| Authorization packet completeness | Requests sent with full failed-trial detail | Every request |
| Claim submission | Time from session to claim sent | Within 48 hours |
Taper sessions given after the authorization ended
Authorization denials caused by missing medication doses or durations
90867 billed again instead of 90869
Unspecified depression codes on TMS claims
Commercial patients authorized through the medical plan instead of the carve-out vendor
Session payments below contracted rates
TMS billing is usually priced as a percentage of monthly collections, commonly 4–9% for behavioral health. Where your clinic falls depends on new patients per month, payer mix, and how much authorization and re-treatment work is involved. Unlike flat-fee staffing models, a percentage fee means you pay more only when you collect more. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| Authorization packets | Built from memory | Built to each payer's criteria |
| Session tracking | Spreadsheets | Updated after every treatment |
| TMS coding | 90867 errors common | Frequency rules checked on every claim |
| Re-treatment requests | Often denied | Built around re-treatment criteria |
| Absences and turnover | Billing stops | Backup team keeps working |
| Cost | Salary, benefits, software | One fee tied to collections |
"Patients mid-course will lose sessions." Every active authorization and session count is loaded before go-live.
"Our cash flow will drop." We work old TMS claims in parallel while new ones go out.
"We'll lose visibility." You see every claim in your system, plus a monthly review call.
"We're locked in." You're not. The agreement is month-to-month with 30-day notice.
TMS billing follows CPT and ICD-10-CM guidelines, Medicare LCD and billing article requirements, NCCI edits, payer medical policies, mental health parity rules, and HIPAA. We sign a Business Associate Agreement before accessing any patient data.
Course-level control: Every session tracked against its approval.
Approvable packets: Failed-trial histories built to each payer's criteria.
Correct coding: 90867, 90868, and 90869 frequency rules on every claim.
Interventional psychiatry depth: TMS, Spravato, and medication management billed by one team.
Nevada payer expertise: Noridian, five Medicaid MCOs, carve-out vendors, and local commercial plans.
No lock-in: Month-to-month agreement with 30-day notice.
Las Vegas: Standalone TMS clinics, interventional psychiatry centers, and multi-site groups offering TMS and Spravato. Las Vegas billing
Henderson: Psychiatric practices adding TMS for commercially insured patients. Henderson billing
North Las Vegas: Clinics serving many Medicare Advantage and Medicaid MCO patients. North Las Vegas billing
Reno: TMS providers serving Washoe County and patients from rural northern Nevada. Reno billing
Carson City: Outpatient psychiatry practices bringing TMS to the capital region. Carson City billing
We also support TMS programs in Sparks, Summerlin, Pahrump, and Elko.
We help Nevada TMS clinics win approvals, track every session, bill the right codes, and recover denied courses.
Free 90-day review · No obligation · HIPAA compliant
Behavioral health billing servicesPsychiatry billing servicesSpravato billing servicesPrimary care billing servicesTMS billing services manage the revenue cycle for transcranial magnetic stimulation: benefits verification, prior authorization, session tracking, coding, claim submission, payment posting, denial appeals, and A/R follow-up for the full course.
90867 for the initial session with cortical mapping and motor threshold, 90868 for each later treatment session, and 90869 for sessions where motor threshold is re-determined.
A typical approved course for depression is about 36 sessions, including taper, though limits vary by payer. Sessions beyond the approved count need an extension before they're given.
Yes, for adults with treatment-resistant major depressive disorder who meet Noridian's criteria in LCD L37086.
Usually a confirmed major depressive disorder diagnosis coded to severity, several failed antidepressant trials with dose and duration, often a psychotherapy trial, baseline symptom scores, and a treatment plan.
It varies. Since 2026, Medicare Advantage and Medicaid plans must decide standard prior authorization requests within 7 calendar days and expedited ones within 72 hours. A complete packet avoids extra requests for information.
Only when a significant, separately identifiable service is documented, usually with modifier 25. Routine monitoring during TMS is part of the TMS code.
Some plans cover it, but many limit TMS coverage to depression. We verify each patient's plan before treatment begins.
Yes. We build re-treatment requests around payer criteria, which usually require documented response to the previous course.
Yes. We handle payer enrollment, coverage research by device and indication, intake checklists, and billing setup before your first patient.
Most behavioral health billing is priced at 4–9% of collections. We give a fixed quote after a free audit.