Policy update for transcranial magnetic stimulation codes — CPT 90867, 90868, 90869

CPT^® codes 90867, 90868, and 90869 are reimbursable when billed in conjunction with one of the following ICD‑10‑CM diagnosis codes: F32.1, F32.2, F32.3, F32.4, F33.2, F33.9, and F34.1. The new coverage of transcranial magnetic stimulation (TMS) services allows eligible members access to additional mental health treatment options.

Why the change?

In July 2024, the Department of Health Care Services (DHCS) announced that TMS services would become a covered benefit. Previously, TMS was only covered under the county benefit of Specialty Mental Health Services (SMHS). The recent DHCS Non‑Specialty Mental Health Services billing guide now includes the covered benefit details. Aligned with the No Wrong Door policy, care providers and Anthem members are still able to seek this benefit through the county SMHS benefit.

Requirements

These covered benefits must meet the following criteria:

• Prior authorization is required for reimbursement; submit your prior authorization request the same way you currently request prior authorization through our Behavioral Health Utilization Management Team
• Members age 15 years or older
• Allowable modifiers: SA, U7, and 99
• Required ICD‑10‑CM diagnosis codes: F32.2 and F33.2 (for procedure type N)

Resources:

• DHCS policy update for transcranial magnetic stimulation: Policy Update for CPT Codes 90867, 90868 and 90869
• DHCS Non‑Specialty Mental Health Services billing guide: Psychiatric and Psychological Services

If you have any questions, use the Chat with Payer feature in https://Availity.com or reach out to your provider relationship management representative.