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TMS ICD 10 Code and Health Coverage Guide

What is TMS?

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique of stimulating the brain to relieve the symptoms of depression. This method involves placing a small wire coil over the scalp and inducing a current through the coil. The current produces magnetic pulses that can penetrate the scalp through the brain.

TMS therapy is conducted under several stimulation factors, which include:

  • Frequency
  • Intensity
  • Pulse duration
  • Stimulation site

When pulsed in rapid succession, it is called repetitive TMS or rTMS. rTMS can either increase or decrease the activity of the brain depending on the patient’s needs. As a simple procedure, TMS therapy occurs in outpatient settings inside a clinic. It also doesn’t require any major procedures like those requiring anesthesia or sedation.

Health Insurance Coverage

Before receiving TMS therapy, it is best to contact your health insurance provider. These services may or may be covered by them. Today, most health insurance companies are becoming a little more dynamic on their policies and may give leeway as far as covering TMS therapy is concerned.

Here some of the guidelines for TMS therapy coverage. Take note though, this may vary according to your health care plan.

Some healthcare insurance companies consider TMS therapy to be a medical necessity in adults who suffer major depressive disorder. But you may need to first meet the following conditions:

  • Antidepressants failed to provide any improvement with at least four trials
  • You do not respond to any medications in your current condition
  • You tried different evidence-based therapies with at least two trials
  • Inability to tolerate any antidepressant medications in the past – you clearly showed adverse effects to these medications
  • Unable to tolerate electroconvulsive therapy (ECT)
  • Tried several available therapies for your depression but failed over and over again

Furthermore, it should be noted that:

  • TMS therapy should only be conducted in an FDA approved clinic and administered by a licensed physician in a safe and effective manner
  • A licensed physician should write your recommendation for TMS therapy. The doctor needs to review and examine your record thoroughly
  • A licensed physician should be present during the sessions

Under no circumstances that you can undergo TMS therapy if you have any of the following:

  • Aneurysm coils
  • Bullet fragments located near the head
  • Deep brain stimulators
  • Electrodes used to monitor brain activity
  • Facial tattoos with metallic ink
  • Metallic implants
  • Other metal devices or object implanted in the body particularly in the near the head
  • Stents in the neck or brain

TMS Treatment

Once cleared, you should expect TMS therapy to run about five times a week for 6 weeks. Therapy typically last for about 60 minutes inside your doctor’s office. It may take a little longer during the initial treatment as doctors need to place the coil in the correct spots. This will guarantee the best possible stimulation of the brain to relieve symptoms of depression.

However, even with positive results from studies, TMS therapy may not work under the following conditions:

  • Psychological problems that show signs of detachment from reality
  • Depression that sets in for several years
  • Any Electroconvulsive Therapy (ECT) in the past has not worked to improve mood or behavior

Corresponding ICD 10 Codes

Whether for an insurance claim or billing processes, you may also need to have these ICD 10 codes handy:

  •    F32.2

For Major depressive disorder, single episode, severe without psychotic features

  •    F33.2

For Major depressive disorder, recurrent severe without psychotic features

If you have any questions or concerns or would like assistance dealing with your insurance provider, feel free to contact us for assistance.

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TMS of the Palm Beaches

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Delray Beach, FL 33445

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