Medi-Cal says TMS codes 90867, 90868 and 90869 became covered benefits for services on or after August 1, 2024, with authorization and age criteria.
Medi-Cal policy update
Medi-Cal, through the California Department of Health Care Services (DHCS), states that it updated policy for CPT codes 90867, 90868 and 90869. According to the Medi-Cal policy update, the codes became Medi-Cal benefits for dates of service on or after August 1, 2024.
The update addresses therapeutic repetitive transcranial magnetic stimulation, also called TMS, under the three listed billing codes. Medi-Cal identifies the update as applying to specific services and reimbursement requirements rather than describing a broader change to all TMS-related care.
Services named in the update
According to Medi-Cal, CPT code 90867 covers an initial therapeutic repetitive TMS treatment. Medi-Cal says this initial service includes cortical mapping, motor threshold determination, treatment delivery and management.
Medi-Cal states that CPT code 90868 covers subsequent TMS delivery and management on a per-session basis. CPT code 90869, according to Medi-Cal, covers a subsequent motor-threshold re-determination with delivery and management.
The source does not provide additional clinical details about TMS treatment, how many sessions may be involved, or how the listed services may be scheduled.
Authorization, age and diagnosis requirements
Medi-Cal states that a Treatment Authorization Request, or TAR, is required for reimbursement of the listed services. The policy update also states that the age limit is 15 years of age or older.
According to Medi-Cal, the required ICD-10-CM diagnosis codes are F32.2 and F33.2. The update lists allowable modifiers as SA, U7 and 99.
The source does not describe the TAR review process, how long authorization may take, or whether other documentation may be requested. It also does not explain any provider billing steps beyond naming the authorization requirement, modifiers and diagnosis codes.
Provider manual information to follow
Medi-Cal says updated provider manual sections will be released in a future Medi-Cal Update. The July 9, 2024 notice does not include those future manual sections or state when they will be published.
The policy notice is a Medi-Cal coverage and reimbursement update for the three specified CPT codes. It does not name individual treatment locations or describe availability of TMS services in particular California communities.
What this means for California patients
For Californians looking for treatment locally, the directory lists 382 published clinics in California; Medi-Cal’s update identifies TMS billing codes, authorization requirements and age criteria that may be relevant when discussing coverage with a provider or health plan.
This is general information, not medical advice.
More California reporting on access & coverage.
This report is educational and is not medical advice. Coverage, availability and eligibility can change; verify details with the named source or your care team.