About this policy
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD L34641 Transcranial Magnetic Stimulation (TMS). Documentation Requirements All documentation must be maintained in the patient’s medical record and available to the contractor upon request. The medical record documentation must support the medical necessity of the services as directed in this policy. The attending physician must monitor and document the patient's clinical progress during treatment. The attending physician must use evidence-based validated depression monitoring scales such as the Geriatric Depression Scale (GDS), the Personal Health Questionnaire Depression Scale (PHQ-9), the Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAM-D), the Montgomery Asberg Depression Rating Scale (MADRS), the Quick Inventory of Depressive Symptomatology (QIDS) or the Inventory for Depressive Symptomatology Systems Review (IDS-SR) to monitor treatment response and the achievement of remission of symptoms. Utilization Guidelines The treatment must be provided by use of a device approved by the FDA for the purpose of supplying TMS. It is expected that the services would be performed as indicated by current medical literature and standards of practice. Services performed in excess of established parameters may be subject to review for medical necessity. TMS is reasonable and necessary for up to 20 visits over a 4-week period followed by 5 visits for tapering for those in remission; for those who show at least a 25% improvement by means of the standard tests for depression, the therapy may be continued for an additional 2 weeks (an additional 10 visits) with an additional 6 visits for tapering. Retreatment may be considered for patients who met the guidelines for initial treatment and subsequently developed relapse of depressive symptoms if the patient responded to prior treatments as evidenced by a greater than 50% improvement in standard rating scale measurements for depressive symptoms or if there were a relapse after remission (e.g., GDS, PHQ-9, BDI, HAM-D, MADRS, QIDS or IDS-SR score.) A repeat treatment program is allowed as above. Maintenance therapy is considered experimental/investigational and therefore not medically necessary.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.