CPT Code 90869: TMS Subsequent Delivery

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• 90869

CPT Code 90869: TMS Subsequent Delivery

CPT code 90869 for subsequent TMS treatment delivery and management. Billing rates, coverage, and reimbursement guidance for behavioral health clinics.

Quick Reference

Code

90869

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90869: Therapeutic Repetitive TMS, Subsequent Delivery

CPT code 90869 covers the subsequent delivery and management of therapeutic repetitive transcranial magnetic stimulation (TMS) treatment. For behavioral health providers offering TMS services, this code is used for the majority of sessions in a standard TMS treatment course after the initial planning and setup have been completed. TMS is a growing modality in behavioral health, particularly for treatment-resistant depression, and understanding proper billing for subsequent sessions is essential for maintaining revenue integrity.

TMS is a non-invasive brain stimulation technique that uses magnetic pulses to stimulate specific areas of the brain associated with mood regulation. A standard course of TMS treatment involves 20 to 36 sessions delivered over four to six weeks. After the initial treatment planning session (billed under 90867), subsequent sessions are billed under 90868 (with motor threshold redetermination) or 90869 (without motor threshold redetermination). Because the majority of sessions in a treatment course do not require motor threshold redetermination, 90869 is the most frequently billed TMS code.

Definition and Purpose

CPT code 90869 is defined as therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, subsequent delivery and management, per session. This code specifically covers sessions in which the TMS treatment is delivered without performing a new motor threshold determination.

The purpose of 90869 is to capture the clinical work involved in delivering subsequent TMS treatments after the initial setup has been completed. Each session involves preparing the patient, positioning the TMS coil, delivering the magnetic stimulation according to the treatment parameters established during the initial planning session, monitoring the patient during treatment, and managing any clinical concerns that arise.

Key characteristics of 90869 include:

• Service type: Subsequent TMS treatment delivery and management
• Motor threshold: Not redetermined during this session (use 90868 when redetermination is performed)
• Billing unit: Per session
• Treatment course: Typically part of a 20- to 36-session treatment course
• Setting: Outpatient clinic, behavioral health facility, or hospital outpatient department

When to Use 90869 in Behavioral Health

90869 is appropriate for the routine subsequent TMS treatment sessions that make up the bulk of a standard treatment course.

Treatment-resistant depression: The most common indication for TMS in behavioral health is major depressive disorder that has not responded to adequate trials of antidepressant medication. After the initial TMS treatment planning session (90867), subsequent sessions are billed under 90869 when motor threshold redetermination is not performed.

Obsessive-compulsive disorder: TMS has FDA clearance for OCD treatment. Subsequent OCD treatment sessions follow the same billing pattern as depression, with 90869 used for sessions without motor threshold redetermination.

Maintenance TMS: Some patients who respond well to an initial TMS treatment course receive maintenance or taper sessions to sustain their improvement. These follow-up sessions are billed under 90869 when motor threshold redetermination is not performed.

Standard treatment course sessions: In a typical treatment course, sessions two through the final session are generally billed under 90869, with occasional sessions billed under 90868 when the treating provider determines that motor threshold redetermination is clinically appropriate.

Providers should use 90868 instead of 90869 when motor threshold redetermination is performed during the session. The initial treatment planning session with cortical mapping should be billed under 90867.

Documentation Requirements

Documentation for each TMS session billed under 90869 must support the medical necessity and clinical appropriateness of the treatment.

Treatment parameters: Document the TMS treatment parameters used for each session, including the stimulation site, the intensity as a percentage of motor threshold, the frequency of stimulation, the number of pulses delivered, and the total treatment time. Note whether the parameters are consistent with the treatment plan established during the initial 90867 session.

Patient monitoring: Document the patient’s condition before, during, and after the treatment session. Record any side effects or adverse events, including headache, scalp discomfort, or other symptoms. Note the patient’s tolerance of the treatment.

Clinical assessment: Include a brief clinical assessment of the patient’s current symptoms at each session. This ongoing assessment helps track treatment response and supports the continued medical necessity of the treatment course.

Treatment course tracking: Document the session number within the overall treatment course (for example, “session 15 of 30”). This helps payers understand the context of each session within the broader treatment plan.

Provider supervision: Document the level of provider supervision for each session. TMS treatment delivery may involve a TMS technician under the supervision of a physician. Clarify who delivered the treatment and who provided clinical oversight.

Deviation documentation: If any deviations from the standard treatment protocol occur, such as a shortened session due to patient discomfort or equipment issues, document the deviation and the clinical rationale for continuing or modifying treatment.

Billing and Reimbursement

As of March 2026, TMS reimbursement rates reflect the specialized nature of the equipment and expertise required.

Medicare: Medicare covers TMS for treatment-resistant depression in most regions. Reimbursement for 90869 is typically in the range of $120 to $170 per session, depending on geographic locality and the site of service (office vs. hospital outpatient department). Rates are determined by the Medicare Physician Fee Schedule.

Medicaid: Coverage for TMS under Medicaid varies significantly by state. Some states cover TMS for treatment-resistant depression, while others do not include TMS in their covered benefits. Verify state-specific coverage before initiating treatment.

Commercial payers: Most major commercial payers cover TMS for treatment-resistant depression when prior authorization requirements are met. Reimbursement rates are contract-dependent and may range from $150 to $300 per session. Some payers have specific policies limiting the number of sessions covered per treatment course.

Billing tips:

• Obtain prior authorization before initiating the TMS treatment course, as most payers require it
• Bill 90869 once per treatment session
• Track session counts carefully to stay within payer-approved session limits
• Submit claims promptly after each session to maintain cash flow throughout the treatment course
• Maintain documentation of treatment-resistance criteria to support the initial authorization and any reauthorization requests

Common Modifiers

Modifiers that may apply when billing 90869 include:

Verify payer-specific modifier requirements for TMS codes, as policies vary significantly between payers.

• Modifier 59: Distinct procedural service — used when TMS needs to be distinguished from other services on the same date, such as a psychotherapy session provided before or after the TMS treatment
• Modifier 76: Repeat procedure by same physician — rarely needed but may apply in unusual situations where two TMS sessions are delivered on the same date
• Modifier 25: Significant, separately identifiable E&M service — append to an E&M code if a separately identifiable E&M service is provided on the same date as TMS
• Modifier TC: Technical component — some payers split TMS into technical and professional components; use TC when billing only the technical component

Compliance Considerations

TMS billing involves significant compliance considerations due to the high cost of treatment and the relatively new adoption of the technology.

Medical necessity criteria: Ensure that the patient meets documented medical necessity criteria for TMS treatment. Most payers require evidence of treatment-resistant depression, defined as failure to respond to at least one adequate antidepressant trial (some payers require failure of two or more trials). Maintain documentation of prior treatment failures.

Prior authorization compliance: Most payers require prior authorization for TMS treatment courses. Ensure that authorization is obtained before initiating treatment and that the approved number of sessions is not exceeded without reauthorization. Billing beyond the authorized session count can result in claim denials and recoupment.

Supervision requirements: Verify and comply with payer and state requirements for physician supervision during TMS treatment delivery. Some payers require the treating physician to be physically present during TMS sessions, while others allow general supervision with a technician performing the treatment delivery.

Equipment and facility standards: Ensure that TMS equipment meets FDA requirements and is properly maintained. Document equipment maintenance and calibration records. Some payers may have specific facility requirements for TMS services.

Accurate code selection: Use the correct code for each session. Use 90867 for the initial planning session, 90868 when motor threshold redetermination is performed, and 90869 for routine subsequent sessions. Miscoding between 90868 and 90869 is a common error that can trigger audit attention.

Outcome tracking: While not strictly a billing requirement, tracking and documenting patient outcomes supports the medical necessity of ongoing treatment and can be valuable during payer reviews or audits.

Related Billing Codes

• 90849
• 90853
• 90863
• 90870
• 90875
• 90876

Common questions

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