COVID-19 pandemic has put an extremely serious challenge on doctors and other practitioners all over the country. This challenge is not limited to constant protection and saving us from a new deadly virus. Since early 2020, millions of people worldwide have suffered from mental health disorders. Specifically, depression has become extremely popular among all the people who have been on a rollercoaster of lockdowns, recessions, PCR tests, and vaccinations for almost two years already.
There are various ways to treat clinical depression. While some healthcare providers prefer to practice traditional medication/therapy sessions, some are offering more innovative treatment methods to their patients. Transcranial Magnetic Stimulation or “TMS therapy” is among such methods currently offered by psychiatrists nationwide.
Basically, TMS therapy implies an exposition of a patient’s brain to certain electromagnetic fields generated by a TMS machine. These fields reduce symptoms of depression in your patients. TMS treatment sessions typically last about 45 minutes, and a total number of 20 to 30 visits is required for clinical effectiveness. The procedure is non-invasive since the coil is placed against the patient’s head near their forehead. Also, no anesthesia or radiation is used during the procedure. Everything is accomplished with a help of a magnetic coil, attached to a cumbersome device. A magnetic pulse generated by the coil hits your patient’s prefrontal cortex, somehow stimulating it. On the screen, you can see the steps of the TMS therapy session. At first, the device stimulates neurons in the prefrontal cortex. Then, these neurons go deeper into other brain neurons. And finally, the stimulation of those deep neurons causes the desired effect. As it is implied in the last step, the patient goes back to normal right after the session, no additional activities are required, that’s why it is great to know that TMS therapy has very few side effects, such as a brief headache. An entire session takes about 15-40 minutes, with the patient reclining comfortably in the treatment chair, awake and alert, safe and sound.
TMS therapy is an FDA-approved clinical depression treatment for people 18 years or older. It is covered by the majority of commercial payers, as well as by Medicare/Medicaid. However, TMS has to be prescribed by an eligible psychiatrist. A rendering physician must be approved by Medicare and accept an assignment. If this is not the case, the services would not be covered by Medicare, creating an out-of-pocket expense for the patient. The service itself can be performed by a prescribing physician, or, in some cases, a clinical staff, such as a technician.
There are three CPT codes that can be used while billing for this therapy:
• 90867 (initial motor threshold determination, including delivery and management)
• 90868 (subsequent therapy session)
• 90869 (subsequent threshold determination)
The first one can be performed only by an eligible physician, while the two subsequent codes can be furnished by a technician under the doctor’s supervision.
There are many enterprises in the USA that distribute TMS machines. Should you have any questions about the coverage and billing of this service – contact your account representative.