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Transcranial magnetic stimulation clinics

TMS Billing Services 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.

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One TMS course, six weeks

Illustrative

First treatment, with motor threshold

Later sessions, ordering provider on each claim

First-treatment code not billed again

First sessionSix weeks
First Coast and Novitas cover up to six weeks, and the first-treatment code is billed once in six weeks.
Billing
4-8%
of what we collect for you
Credentialing
$150
per application, per provider
Contract
None
no long-term contract
Software
SimplePractice
or the system you already use

Where a TMS course stops getting paid

A course bills many sessions against one approval, so a mistake at the start repeats.

1

Medication history the policy cannot find

Medicare contractors count failed medication trials differently. 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 from a psychiatrist (MD or DO) who examined the patient. An order that fits one region can fail in the next.

3

The ordering provider missing from the claim

First Coast and Novitas say every TMS claim must carry the ordering provider's name and NPI. Leave it off and the claim does not meet the rule.

4

The wrong session code on the wrong day

TMS has three codes, one for the first treatment. That code is billed once per episode, never with the other two, and not more than once in six weeks.

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

Medtransic runs

  • Benefits checks before the first session
  • Prior authorization requests where the plan requires them, built from your chart notes
  • A check of each new course against your Medicare contractor's criteria
  • Session claims with the right code and the ordering provider on each
  • Payment posting, denials and appeals, and A/R follow-up
  • Credentialing for the psychiatrists and other prescribers who order TMS

Your practice keeps

  • Patient selection, mapping, dosing and every clinical decision
  • Chart notes, rating scales and the physician's review before treatment
  • Your EHR and your patient relationships
  • Approving write-offs and patient balance policies

What Medicare's TMS policies require before treatment starts

Medicare has no national TMS policy. Each Medicare contractor writes its own, and seven are in force as of October 2026.

  1. 01

    Medication trials

    What Medicare contractors ask
    Noridian, WPS and Wellpoint Federal: one failed trial from at least two drug classes. Palmetto and CGS: two trials. First Coast and Novitas: one or more, or intolerance.
  2. 02

    Psychotherapy

    What Medicare contractors ask
    Required by most. WPS, for example, wants an evidence-based trial without significant improvement, documented with rating scales. First Coast and Novitas do not list it.
  3. 03

    Who orders

    What Medicare contractors ask
    First Coast and Novitas: a psychiatrist who examined the patient face to face. CGS: ordered and directly supervised by a psychiatrist. Wellpoint Federal: any examining physician, or an NP or PA where state scope allows.
  4. 04

    Course length

    What Medicare contractors ask
    First Coast and Novitas: up to six weeks for severe major depression.
  5. 05

    Retreatment

    What Medicare contractors ask
    WPS: only after more than a 50% improvement on rating scales. Wellpoint Federal and CGS: no maintenance TMS.
  6. 06

    OCD

    What Medicare contractors ask
    Palmetto: after two medication trials of at least 8 weeks and at least 8 weeks of psychotherapy. Noridian, Wellpoint Federal, CGS, First Coast and Novitas: not covered.

Credentialing the clinicians who order TMS

Coverage depends on who orders TMS, so each prescriber is set up before their patients start.

  1. 1

    Match prescribers to order rules

    We check who orders TMS in your clinic against your Medicare contractor's rules, because a nurse practitioner may order under one contractor but not another.

  2. 2

    NPI and license in order

    Every ordering provider needs an NPI that can go on the claim and an active license in the state where patients are treated.

  3. 3

    Medicare enrollment in PECOS

    We file Medicare enrollment in PECOS, Medicare's online enrollment system, side by side with your commercial network applications.

  4. 4

    Commercial and Medicaid applications

    We follow each application until it is approved and show its stage in your client portal.

Payment and payer notes for TMS

Medicare has no national TMS fee

Medicare lists all three TMS codes as contractor-priced, with no national payment amount. What a session pays depends on where your clinic is.

Documentation that holds up on review

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

Devices and protocols

FDA first permitted marketing of TMS for depression in 2008, and has since cleared theta burst (2018), SAINT (2022) and NeuroStar as an add-on for ages 15 to 21 (2024). FDA clearance does not mean a payer covers that use.

Commercial and Medicaid plans

These plans write their own TMS rules, including whether approval is needed before treatment. We check the patient's own plan before the first session.

Your client portal, included

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.
See the client portal →
The billing screen in the Medtransic client portal: totals billed, paid, adjusted and outstanding, a twelve-month chart and A/R by age.
The billing screen. Shown with sample data. It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon.

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 consultation.

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 consultation before you sign is free.

Keep reading

+ Sources: 17 checked 2026-10-04

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HIPAA Compliant & SecureDedicated Account ManagerNo Long-Term Contract