LCD Reference Article Billing and Coding Article

Billing and Coding: Transcranial Magnetic Stimulation (TMS)

A57598

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57598
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Transcranial Magnetic Stimulation (TMS)
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
04/25/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Social Security Act:
1862 (a) (1)(A) Medically Reasonable & Necessary.
1862 (a) (1)(D) & (E) Investigational or Experimental.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L34641 Transcranial Magnetic Stimulation (TMS).

Documentation Requirements

All documentation must be maintained in the patient’s medical record and available to the contractor upon request. The medical record documentation must support the medical necessity of the services as directed in this policy.

The attending physician must monitor and document the patient's clinical progress during treatment. The attending physician must use evidence-based validated depression monitoring scales such as the Geriatric Depression Scale (GDS), the Personal Health Questionnaire Depression Scale (PHQ-9), the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAM-D), the Montgomery Asberg Depression Rating Scale (MADRS), the Quick Inventory of Depressive Symptomatology (QIDS) or the Inventory for Depressive Symptomatology Systems Review (IDS-SR) to monitor treatment response and the achievement of remission of symptoms.

Utilization Guidelines

The treatment must be provided by use of a device approved by the FDA for the purpose of supplying TMS.

It is expected that the services would be performed as indicated by current medical literature and standards of practice. Services performed in excess of established parameters may be subject to review for medical necessity.

TMS is reasonable and necessary for up to 20 visits over a 4-week period followed by 5 visits for tapering for those in remission; for those who show at least a 25% improvement by means of the standard tests for depression, the therapy may be continued for an additional 2 weeks (an additional 10 visits) with an additional 6 visits for tapering.

Retreatment may be considered for patients who met the guidelines for initial treatment and subsequently developed relapse of depressive symptoms if the patient responded to prior treatments as evidenced by a greater than 50% improvement in standard rating scale measurements for depressive symptoms or if there were a relapse after remission (e.g., GDS, PHQ-9, BDI, HAM-D, MADRS, QIDS or IDS-SR score.) A repeat treatment program is allowed as above.

Maintenance therapy is considered experimental/investigational and therefore not medically necessary.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(2 Codes)
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Group 1 Codes
Code Description
F32.2 Major depressive disorder, single episode, severe without psychotic features
F33.2 Major depressive disorder, recurrent severe without psychotic features
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Codes not listed above

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/25/2024 R3

Posted 04/25/2024 Review completed 03/18/2024 with minor typographical error corrected to reflect AMA formatting.

05/26/2022 R2

Posted 05/26/2022: Review completed 04/11/2022: Minor typographical errors corrected throughout the article. No change in coverage.

07/30/2020 R1

Added in Article Guidance: L34641 Transcranial Magnetic Stimulation (TMS). Review completed 07/07/2020 with no change in coverage.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/16/2024 04/25/2024 - N/A Currently in Effect You are here
05/17/2022 05/26/2022 - 04/24/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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