CPT® Code 90867

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, as described by CPT® Code 90867, is a non-invasive procedure primarily utilized for the management of depression in patients who have not responded to other therapeutic interventions. This innovative treatment modality employs magnetic fields to stimulate nerve cells in specific areas of the brain that are associated with mood regulation and other psychological disorders. Conditions such as anxiety, obsessive-compulsive disorder, auditory hallucinations, and migraines may also be addressed through this technique. The underlying principle of rTMS is to modulate the activity of brain regions that may be either overactive or underactive; for instance, individuals with depression often exhibit reduced activity in the left prefrontal cortex. During the procedure, a large electromagnetic coil is positioned against the scalp over the targeted brain region. This coil generates painless electric currents that stimulate the underlying nerve cells, thereby influencing the brain's biochemistry, neuronal firing patterns, and neurotransmitter levels, including serotonin. The initial session, as indicated by code 90867, encompasses several critical components: cortical mapping, motor threshold determination, and the delivery and management of the treatment. The physician conducts a thorough assessment to identify the most effective sites on the forehead for magnet placement, determines the optimal rate of stimulating pulses, and calculates the appropriate dose of magnetic energy required for effective treatment. The process involves activating the electromagnetic coil at a frequency of up to 10 times per second, producing a tapping or clicking sound and a corresponding tapping sensation on the patient's head. This comprehensive approach ensures that the treatment is tailored to the individual needs of the patient, with adjustments made as necessary based on their response and any side effects experienced during the course of therapy.