TMS Billing and Prior Authorization for TMS Clinics

Medtransic handles TMS billing for transcranial magnetic stimulation clinics. Before the first session, we check the patient's plan and match the chart to the coverage rules of your Medicare contractor or commercial plan. Then we bill each session and follow every claim until it is paid, inside SimplePractice, TherapyNotes or the system you already use. We also credential your prescribers. Billing is 4-8% of what we collect for you. Credentialing is $150 per application, per provider. There is no long-term contract.

Last reviewed 2026-10-04.

Where a TMS course stops getting paid

A TMS course is many sessions billed against one approval and one set of chart notes. When the start is wrong, every session after it carries the same problem.

  1. The chart does not show the medication history the policy asks for

    Medicare contractors count failed medication trials differently. Some want one trial from at least two drug classes in the current episode, some want two trials, and two accept one or more. A chart that lists drugs without doses, length of trial and outcome leaves the reviewer guessing.

  2. The wrong clinician signed the order

    Most Medicare contractors require the order to come from a psychiatrist (MD or DO) who examined the patient and reviewed the record. One contractor also accepts other physicians and, where state law allows, nurse practitioners and physician assistants. An order that fits one region can fail in the next.

  3. The ordering provider is missing from the claim

    Two Medicare contractors, First Coast and Novitas, say every TMS claim must carry the ordering provider's name and NPI. Their billing articles spell out where it goes on paper and electronic claims. Leave it off and the claim does not meet the rule.

  4. Sessions billed with the wrong code on the wrong day

    TMS uses three codes: the first treatment with planning and motor threshold work, each later session, and a later session where the motor threshold is measured again. Medicare contractor articles say the first-treatment code is billed once per episode, never with the other two, and not more than once in six weeks. The re-measure code is not billed with either of the others.

What we handle for your TMS clinic, and what stays with you

What we run

What stays with you

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?

Every claim with its stage and amount, the denials we're working, and your receivables by age.

Where is my application with Aetna?

Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.

What do you still need from me?

One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

What Medicare's TMS policies require before treatment starts

Medicare has no national TMS policy. Each Medicare contractor writes its own local coverage policy, and seven are in force as of October 2026. Medicare does list TMS for severe major depression among the mental health services it may cover.

Medication trials, counted by your contractor. Noridian, WPS and Wellpoint Federal ask for one failed trial from at least two drug classes in the current episode. Palmetto and CGS ask for two trials; CGS defines a failure as less than a 50% drop in symptoms after at least six weeks at the labeled adult dose. First Coast and Novitas accept one or more failed trials, or intolerance to medication.

Psychotherapy, for most contractors. WPS, for example, requires a trial of evidence-based psychotherapy without significant improvement, documented with standardized rating scales. First Coast and Novitas do not list a psychotherapy requirement. We read your contractor's policy, not a summary of all of them.

The order and supervision. First Coast and Novitas want the order from a psychiatrist who examined the patient face to face. CGS does not cover TMS unless a psychiatrist ordered it and it is given under a psychiatrist's direct supervision. Wellpoint Federal accepts an order from any physician who examined the patient, or a nurse practitioner or physician assistant where state scope allows.

Length of the course. First Coast and Novitas cover TMS for severe major depression for up to six weeks. Plan the course and the request around that window when your patients are in Florida, Texas or another state those contractors serve.

Retreatment and maintenance. WPS covers retreatment only when the prior course gave more than a 50% improvement on standard rating scales. Wellpoint Federal and CGS do not cover maintenance TMS. Track each patient's scores from the first course so a retreatment request has the numbers it needs.

OCD is covered in some regions only. FDA permitted marketing of a deep TMS system as an add-on treatment for adult OCD in 2018. Among Medicare contractors, Palmetto covers TMS for OCD after two medication trials of at least 8 weeks and at least 8 weeks of evidence-based psychotherapy. Noridian, Wellpoint Federal, CGS, First Coast and Novitas do not cover it.

Credentialing the clinicians who order TMS

Medicare contractors tie TMS coverage to who orders it, and some require the ordering provider on every claim. So each prescriber in your clinic needs to be set up correctly with each payer before their patients start a course.

  1. Match each prescriber to the order rules

    We note who orders TMS in your clinic and check that against your Medicare contractor's rules. A nurse practitioner who can order under one contractor may not be able to under another.

  2. NPI and license details in order

    Every ordering provider needs an NPI that can go on the claim, plus an active license in the state where patients are treated. Group details and tax ID come next if you bill as a clinic.

  3. Medicare enrollment

    Medicare's enrollment application is filed in PECOS, Medicare's online enrollment system. It runs separately from commercial network applications, so we file both side by side.

  4. Commercial and Medicaid applications

    We submit each application, follow up until it is approved, and show its stage in your client portal so you know when that payer's patients can start.

Credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer.

Payment and payer notes for TMS

Medicare has no national TMS fee

Medicare's fee schedule lists all three TMS codes as contractor-priced, with no national payment amount. Each Medicare contractor sets its own rates, so what a session pays depends on where your clinic is.

Documentation that holds up on review

Novitas and First Coast say the chart must show the physician met the patient face to face at the first assessment and again when clinical status changes. It must also show the physician's review of contraindications before the course begins.

Devices and protocols

FDA first permitted marketing of TMS for depression in 2008. It has since cleared a theta burst system (2018), the SAINT system (2022), and NeuroStar as an add-on treatment for patients aged 15 to 21 (2024). FDA clearance does not mean a payer covers that use, so we check the plan first.

Commercial and Medicaid plans

Commercial and Medicaid plans write their own TMS rules, including whether approval is needed before treatment. We check the patient's own plan before the first session rather than assume it follows Medicare.

When we are not the right fit

If your clinic only sees self-pay TMS patients, you do not need a billing company. We are useful once you bill insurance or want to.

We do not choose patients, protocols or devices for you, and we will not send a claim the chart does not support. If a course does not meet the payer's criteria, we tell you before treatment starts.

Questions TMS clinic owners ask us

Does Medicare cover TMS therapy?

Yes, for severe major depression, when the patient meets the criteria in your Medicare contractor's local policy. There is no single national policy. Each contractor sets its own rules on medication trials, psychotherapy, who orders and retreatment.

How much does Medicare pay for a TMS session?

There is no national amount. Medicare lists the TMS codes as contractor-priced, so each Medicare contractor sets the rate. We look up what your contractor pays during the free revenue audit.

Does Medicare cover maintenance TMS or retreatment?

It depends on the contractor. Wellpoint Federal and CGS do not cover maintenance TMS. WPS covers retreatment when the first course improved rating scale scores by more than 50%.

Can a nurse practitioner order TMS for Medicare patients?

Only under some contractors. Wellpoint Federal allows nurse practitioners and physician assistants to order where state scope allows. Most other contractors require a psychiatrist (MD or DO).

Is TMS for OCD covered by Medicare?

Under Palmetto, yes, when the patient meets its criteria. Noridian, Wellpoint Federal, CGS, First Coast and Novitas do not cover TMS for OCD.

What does Medtransic charge for TMS billing?

Billing is 4-8% of what we collect for you, with no long-term contract. Credentialing is $150 per application, per provider. You get a dedicated account manager, and the revenue audit before you sign is free.

Sources

Outside facts on this page were checked against these sources on the date shown.

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