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90865
Quick jump to procedure code: Printer Friendly Version
90868

CPT® 90867: THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; INITIAL, INCLUDING CORTICAL MAPPING, MOTOR THRESHOLD DETERMINATION, DELIVERY AND MANAGEMENT

Short Description: Tcranial magn stim tx plan

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $220.35
2016 APC Code: 5722
Level 2 Diagnostic Tests and Related Services

2016 OPPS Status Indicator: S

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
No ICD-9 claims data for this code.

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

90867 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 90867

CCI and MUE Edits*         Hide this section.

CCI Edits for 90867
Denied Codes (1)
Effective
Modifier
Accepted (2)
90791 Psych diagnostic evaluation
10/01/2014 No
90792 Psych diag eval w/med srvcs
10/01/2014 No
90832 Psytx pt&/family 30 minutes
01/01/2013 Yes
90833 Psytx pt&/fam w/e&m 30 min
01/01/2013 Yes
90834 Psytx pt&/family 45 minutes
01/01/2013 Yes
90836 Psytx pt&/fam w/e&m 45 min
01/01/2013 Yes
90837 Psytx pt&/family 60 minutes
01/01/2013 Yes
90838 Psytx pt&/fam w/e&m 60 min
01/01/2013 Yes
90839 Psytx crisis initial 60 min
01/01/2013 No
90840 Psytx crisis ea addl 30 min
01/01/2013 No
0333T Visual ep acuity screen auto
01/01/2014 Yes
0359T Behavioral id assessment
10/01/2014 No
0360T Observ behav assessment
10/01/2014 No
0361T Observ behav assess addl
10/01/2014 No
0362T Expose behav assessment
10/01/2014 No
0363T Expose behav assess addl
10/01/2014 No
0364T Adaptive behavior treatment
10/01/2014 No
0365T Adaptive behavior tx addl
10/01/2014 No
0366T Group behavior treatment
10/01/2014 No
0367T Group behav treatment addl
10/01/2014 No
0368T Behavior treatment modified
10/01/2014 No
0369T Behav treatment modify addl
10/01/2014 No
0370T Fam behav treatment guidance
10/01/2014 No
0371T Mult fam behav treat guide
10/01/2014 No
0372T Social skills training group
10/01/2014 No
0373T Exposure behavior treatment
10/01/2014 No
0374T Expose behav treatment addl
10/01/2014 No
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
10/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
10/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
10/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
10/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
10/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
10/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
10/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
10/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
10/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
10/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
10/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
10/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
10/01/2012 Yes
12020 Closure of split wound
10/01/2012 Yes
12021 Closure of split wound
10/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
10/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
10/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
10/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
10/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
10/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
10/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
10/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
10/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
10/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
10/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
10/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
10/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
10/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
10/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
10/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
10/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
10/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
10/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
10/01/2012 Yes
13100 Cmplx rpr trunk 1.1-2.5 cm
10/01/2012 Yes
13101 Cmplx rpr trunk 2.6-7.5 cm
10/01/2012 Yes
13102 Cmplx rpr trunk addl 5cm/<
10/01/2012 Yes
13120 Cmplx rpr s/a/l 1.1-2.5 cm
10/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
10/01/2012 Yes
13122 Cmplx rpr s/a/l addl 5 cm/>
10/01/2012 Yes
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
10/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
10/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
64461 Pvb thoracic single inj site
01/01/2016 No
64463 Pvb thoracic cont infusion
01/01/2016 No
64486 Tap block unil by injection
01/01/2015 No
64487 Tap block uni by infusion
01/01/2015 No
64488 Tap block bi injection
01/01/2015 No
64489 Tap block bi by infusion
01/01/2015 No
90845 Psychoanalysis
01/01/2011 Yes
90846 Family psytx w/o patient
01/01/2011 Yes
90847 Family psytx w/patient
01/01/2011 Yes
90849 Multiple family group psytx
01/01/2011 Yes
90853 Group psychotherapy
01/01/2011 Yes
90865 Narcosynthesis
01/01/2011 Yes
90868 Tcranial magn stim tx deli
01/01/2012 No
90869 Tcran magn stim redetemine
01/01/2012 No
90870 Electroconvulsive therapy
01/01/2011 Yes
90880 Hypnotherapy
01/01/2011 Yes
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
95860 Muscle test one limb
01/01/2011 No
95861 Muscle test 2 limbs
01/01/2011 No
95863 Muscle test 3 limbs
01/01/2011 No
95864 Muscle test 4 limbs
01/01/2011 No
95865 Muscle test larynx
01/01/2013 No
95866 Muscle test hemidiaphragm
01/01/2013 No
95867 Muscle test cran nerv unilat
01/01/2013 No
95868 Muscle test cran nerve bilat
01/01/2013 No
95869 Muscle test thor paraspinal
01/01/2013 No
95870 Muscle test nonparaspinal
01/01/2011 No
95907 Nvr cndj tst 1-2 studies
01/01/2013 Yes
95908 Nrv cndj tst 3-4 studies
01/01/2013 Yes
95909 Nrv cndj tst 5-6 studies
01/01/2013 Yes
95910 Nrv cndj test 7-8 studies
01/01/2013 Yes
95911 Nrv cndj test 9-10 studies
01/01/2013 Yes
95912 Nrv cndj test 11-12 studies
01/01/2013 Yes
95913 Nrv cndj test 13/> studies
01/01/2013 Yes
95925 Somatosensory testing
01/01/2011 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
95926 Somatosensory testing
01/01/2011 Yes
95927 Somatosensory testing
01/01/2011 Yes
95928 C motor evoked uppr limbs
01/01/2011 No
95929 C motor evoked lwr limbs
01/01/2011 No
95930 Visual evoked potential test
01/01/2011 Yes
95938 Somatosensory testing
01/01/2012 Yes
95939 C motor evoked upr&lwr limbs
01/01/2012 No
96127 Brief emotional/behav assmt
01/01/2015 No
96150 Assess hlth/behave init
01/01/2013 No
96151 Assess hlth/behave subseq
01/01/2013 No
96152 Intervene hlth/behave indiv
01/01/2013 No
96153 Intervene hlth/behave group
01/01/2013 No
96154 Interv hlth/behav fam w/pt
01/01/2013 No
96155 Interv hlth/behav fam no pt
01/01/2014 No
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96366 Ther/proph/diag iv inf addon
04/01/2016 Yes
96367 Tx/proph/dg addl seq iv inf
04/01/2016 Yes
96368 Ther/diag concurrent inf
04/01/2016 Yes
99201 Office/outpatient visit new
01/01/2012 Yes
99202 Office/outpatient visit new
01/01/2012 Yes
99203 Office/outpatient visit new
01/01/2012 Yes
99204 Office/outpatient visit new
01/01/2012 Yes
99205 Office/outpatient visit new
01/01/2012 Yes
99211 Office/outpatient visit est
01/01/2012 Yes
99212 Office/outpatient visit est
01/01/2012 Yes
99213 Office/outpatient visit est
01/01/2012 Yes
99214 Office/outpatient visit est
01/01/2012 Yes
99215 Office/outpatient visit est
01/01/2012 Yes
99217 Observation care discharge
01/01/2012 Yes
99218 Initial observation care
01/01/2012 Yes
99219 Initial observation care
01/01/2012 Yes
99220 Initial observation care
01/01/2012 Yes
99221 Initial hospital care
01/01/2012 Yes
99222 Initial hospital care
01/01/2012 Yes
99223 Initial hospital care
01/01/2012 Yes
99224 Subsequent observation care
01/01/2012 Yes
99225 Subsequent observation care
01/01/2012 Yes
99226 Subsequent observation care
01/01/2012 Yes
99231 Subsequent hospital care
01/01/2012 Yes
99232 Subsequent hospital care
01/01/2012 Yes
99233 Subsequent hospital care
01/01/2012 Yes
99234 Observ/hosp same date
01/01/2012 Yes
99235 Observ/hosp same date
01/01/2012 Yes
99236 Observ/hosp same date
01/01/2012 Yes
99238 Hospital discharge day
01/01/2012 Yes
99239 Hospital discharge day
01/01/2012 Yes
99241 Office consultation
07/01/2013 Yes
99242 Office consultation
07/01/2013 Yes
99243 Office consultation
07/01/2013 Yes
99244 Office consultation
07/01/2013 Yes
99245 Office consultation
07/01/2013 Yes
99251 Inpatient consultation
07/01/2013 Yes
99252 Inpatient consultation
07/01/2013 Yes
99253 Inpatient consultation
07/01/2013 Yes
99254 Inpatient consultation
07/01/2013 Yes
99255 Inpatient consultation
07/01/2013 Yes
99281 Emergency dept visit
01/01/2012 Yes
99282 Emergency dept visit
01/01/2012 Yes
99283 Emergency dept visit
01/01/2012 Yes
99284 Emergency dept visit
01/01/2012 Yes
99285 Emergency dept visit
01/01/2012 Yes
99291 Critical care first hour
01/01/2012 Yes
99292 Critical care addl 30 min
01/01/2012 Yes
99304 Nursing facility care init
01/01/2012 Yes
99305 Nursing facility care init
01/01/2012 Yes
99306 Nursing facility care init
01/01/2012 Yes
99307 Nursing fac care subseq
01/01/2012 Yes
99308 Nursing fac care subseq
01/01/2012 Yes
99309 Nursing fac care subseq
01/01/2012 Yes
99310 Nursing fac care subseq
01/01/2012 Yes
99315 Nursing fac discharge day
01/01/2012 Yes
99316 Nursing fac discharge day
01/01/2012 Yes
99318 Annual nursing fac assessmnt
01/01/2012 Yes
99324 Domicil/r-home visit new pat
01/01/2012 Yes
99325 Domicil/r-home visit new pat
01/01/2012 Yes
99326 Domicil/r-home visit new pat
01/01/2012 Yes
99327 Domicil/r-home visit new pat
01/01/2012 Yes
99328 Domicil/r-home visit new pat
01/01/2012 Yes
99334 Domicil/r-home visit est pat
01/01/2012 Yes
99335 Domicil/r-home visit est pat
01/01/2012 Yes
99336 Domicil/r-home visit est pat
01/01/2012 Yes
99337 Domicil/r-home visit est pat
01/01/2012 Yes
99341 Home visit new patient
01/01/2012 Yes
99342 Home visit new patient
01/01/2012 Yes
99343 Home visit new patient
01/01/2012 Yes
99344 Home visit new patient
01/01/2012 Yes
99345 Home visit new patient
01/01/2012 Yes
99347 Home visit est patient
01/01/2012 Yes
99348 Home visit est patient
01/01/2012 Yes
99349 Home visit est patient
01/01/2012 Yes
99350 Home visit est patient
01/01/2012 Yes
99374 Home health care supervision
07/01/2013 Yes
99375 Home health care supervision
07/01/2013 Yes
99377 Hospice care supervision
07/01/2013 Yes
99378 Hospice care supervision
07/01/2013 Yes
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99495 Trans care mgmt 14 day disch
01/01/2014 Yes
99496 Trans care mgmt 7 day disch
01/01/2014 Yes
99497 Advncd care plan 30 min
01/01/2016 Yes
G0410 Grp psych partial hosp 45-50
01/01/2011 Yes
G0411 Inter active grp psych parti
01/01/2011 Yes
G0444 Depression screen annual
07/01/2012 Yes
G0445 High inten beh couns std 30m
07/01/2012 Yes
G0446 Intens behave ther cardio dx
07/01/2012 Yes
G0447 Behavior counsel obesity 15m
07/01/2012 Yes
G0459 Telehealth inpt pharm mgmt
10/01/2013 No
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0473 Group behave couns 2-10
07/01/2015 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 90867.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 90867


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   90867 Top 5 Ordering Providers National*
ANDREW MEDVEDOVSKY -MOUNT LAUREL,NJ 35
LANE COOK -KNOXVILLE,TN 29
JARON WINSTON -AUSTIN,TX 28
W WEST -NASHVILLE,TN 27
CHANDRA KATTA -BATON ROUGE,LA 27

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 90867*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 720
Total Services Denied 2014: 187 (26.0%)
National Charges Submitted 2014: $ 437,391.00
National Charges Allowed 2014: $ 123,788.00
National Average (No Modifier) Fee Submitted 2014: $591.71
National Average (No Modifier) Fee Allowed 2014: $233.55


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Psychiatry 598 83.1% $628.07 147 24.6%
Pain Management
(eff. 1/1/02)
39 5.4% $614.05 2 5.1%
Neurology 21 2.9% $561.43 2 9.5%
Licensed clinical social worker 17 2.4% $108.10 17 100.0%
Physical medicine and rehabilitation 16 2.2% $600.00 1 6.3%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 642 89.2% $634.86 163 25.4%
Outpatient hospital 67 9.3% $397.54 16 23.9%
Inpatient psychiatric facility 6 0.8% $396.00 3 50.0%
Nursing facility 1 0.1% $110.00 1 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 669 92.9% $591.71 174 26.0%
GA - Advanced Beneficiary Notice (ABN) on File 23 3.2% $1059.78 0 0.0%
59 - Distinct Procedural Service 10 1.4% $798.29 3 30.0%
25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure 8 1.1% $481.25 4 50.0%
GY 3 0.4% $616.67 3 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
05/29/2016 02:05:01 54.158.29.163

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