Key Takeaways
- Optimizing CPT coding and documentation is essential for maximizing TMS reimbursement rates.
- Automated revenue cycle management tools reduce denials and accelerate payments.
- Outsourcing to a psychiatry-specific billing service ensures higher accuracy and fewer rejected claims.
- See how one psychiatry practice increased TMS revenue by 561%.
As a behavioral health professional, you work day in and day out to deliver exceptional patient care. But as you juggle your primary duties with tasks related to claims, revenue can fall through the cracks.
Insurance companies aren’t making it easier either—denial rates are now between 10%-15%, costing providers over $200 billion annually. All of this presents challenges to offering innovative treatments, leaving many practices struggling to get reimbursed properly. A prime example? Transcranial Magnetic Stimulation (TMS).
If your practice isn’t keeping up with payer policies, CPT code changes, and revenue cycle best practices, you could be losing thousands in uncollected revenue on this novel treatment each month.
The good news: With the right approach, you can increase claim approvals, reduce denials, and maximize your TMS reimbursement rates. Here’s how.
Table of Contents
1. Optimize CPT Codes and Documentation for Psychiatric Reimbursement Rates
Accurate coding is the backbone of sufficient TMS reimbursement rates—and the most common reason for claim denials. Many practices unknowingly lose revenue due to misused or underutilized CPT codes. Even small mistakes in coding can lead to claim rejections, delaying payments and impacting cash flow.
Key CPT Codes for TMS include:
- 90867 – Initial treatment, including mapping
- 90868 – Subsequent treatment sessions
- 90869 – Re-determination of motor threshold
Many Medicare psychiatric reimbursement rates also depend on proper documentation of medical necessity. This means providing detailed session notes, proof of treatment effectiveness, and clear evidence that TMS is being used appropriately.
How to Improve Your Documentation
- Include clear clinical justifications – Payers want to see a history of failed medication trials and psychotherapy attempts.
- Capture treatment progress – Keep track of patient responses over time to support continued coverage.
- Align documentation with insurance guidelines – Requirements vary by insurer, so verify what each one requires.
Avoid These Common Mistakes
- Incorrectly combining multiple codes – Each TMS session should be billed separately.
- Failing to document re-evaluations – Many payers require reassessments after a set number of sessions.
- Using outdated payer policies – Medicare and commercial insurers frequently update their guidelines, so stay current.
When your documentation is clear, thorough, and accurate, insurers have fewer reasons to delay or deny claims.
“Our revenues have gone up. Everything is going through. I’m getting paid for my services and getting paid quickly. We weren’t before Psychiatry-Cloud.”
2. Leverage Automation to Simplify Claims Processing
If your team is manually handling claim submissions, eligibility checks, and follow-ups, you’re wasting valuable time—and opening the door to errors.
Automation is no longer a luxury—it’s a necessity if you want to increase TMS reimbursement rates and reduce denials.
TMS billing is complex, and manual claim submissions slow down cash flow. By leveraging automation, your practice can also improve Medicare psychiatric reimbursement rates and reduce claim rejections.
Some benefits of automated Revenue Cycle Management (RCM) solutions include:
- Real-time eligibility checks – Prevents billing errors before claims are submitted.
- Automated claim generation – Transforms clinical notes directly into insurance claims.
- Faster reimbursements – Reduces delays caused by human error.
Why This Matters for Medicare Psychiatric Reimbursement Rates
Like private insurers, Medicare processes thousands of claims daily, and its automated denial systems flag even the smallest errors. The result? Practices spend weeks—or months—fighting for reimbursement.
An automated billing system prevents this by:
- Flagging missing documentation before claims are submitted
- Ensuring TMS sessions are billed correctly per insurer rules
- Automatically following up on unpaid claims
If your team spends hours correcting billing mistakes and resubmitting claims, automation could free up valuable time and increase your revenue.
3. Outsource to a Psychiatry-Specific Billing Service
Even with automation, TMS reimbursement rates can suffer if your team isn’t deeply familiar with psychiatric billing. The reality is TMS billing isn’t the same as traditional psychiatry billing—and many in-house teams aren’t trained in its nuances
Why Outsourcing Works for Billing
A psychiatry-focused billing service offers:
- Specialized knowledge – Experts understand Medicare psychiatric reimbursement rates and payer-specific requirements.
- Aggressive claims follow-up – Dedicated teams appeal denied claims faster, so you get paid sooner.
- Less administrative burden – Your staff can focus on patient care instead of chasing down payments.
What to Look for in a TMS Billing Partner
- Industry expertise – Does the billing service specialize in psychiatry and behavioral health?
- Dedicated revenue cycle management – Do they proactively track claim denials and underpayments?
- Proven success rates – Can they demonstrate increased revenue for TMS providers?
Outsourcing to a reputable billing service provider that understands psychiatry can be a game-changer for maximizing reimbursements while freeing up time for what matters most—patient care.
Get the TMS Reimbursements You Deserve
Maximizing TMS reimbursement rates requires a proactive approach. With insurance companies denying more claims than ever, you need the right tools and expertise to protect your revenue. By taking action now, you can eliminate billing headaches, increase cash flow, and get paid what you deserve.
