Transcranial Magnetic Stimulation, Follow-Up Treatment Session
CPT 90868
Performed as part of a multi-week course of TMS, most often for depression that has not improved on medication.
No national payment amount
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Did Medicare pay separately for CPT 90868 in Q1 2019? Copy link
Not at a published national rate. CPT 90868 carries status C (carrier-priced) in the Q1 2019 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q1 2019) · effective January 2019 · materially updated Aug 4, 2026 · compact facts
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed the same date of service to check the current NCCI procedure-to-procedure edit between it and 90868.
How often 90868 is billed Copy link
Across Original Medicare in CY2024, 90868 ranked #324 of the 7,879 CPT codes billed to Medicare that year, ranked by patients served or total allowed dollars. Patients who received it in 2024 were billed for it an average of 31.5 times that year — more than once per patient.
2024 Medicare fee-for-service only, national totals — Medicare Advantage, Medicaid and commercial volume are excluded, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2019 fee schedule the rates above come from.
Global period: what 90868's fee already covers Copy link
The fee covers pre-operative and post-operative work on the day of the procedure only — there is no follow-up window afterward. A visit the next day is separately payable.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Common questions Copy link
Why is there no payment amount for 90868?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 90868 be denied or paid less?
Each item below comes from a CMS indicator on this page — not general billing advice.
- Its status indicator is C (carrier-priced) — Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: never separately payable. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill? Copy link
For patientsWhat does CPT code 90868 mean?
CPT code 90868: Transcranial Magnetic Stimulation, Follow-Up Treatment Session. A common example is someone with depression who has tried several antidepressants without much relief and now comes in most weekdays for a few weeks. They sit in a chair, awake, while a device positioned against the head clicks and taps for a stretch of time, then they drive themselves home. No anesthesia and no sedation are involved, which is what makes it different from electroconvulsive therapy.
Billing policy Copy link
What 90868's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 1 | Never separately payable. An assistant at surgery may never be separately paid for this procedure — a statutory restriction. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2019 release (schedule pfs, effective January 2019). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.
Description written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q1 2019 figures, even after a newer release lands.
CPT 90868 Medicare Physician Fee Schedule rate (Q1 2019). Localis. https://localishealth.com/cpt/90868/2019/A