TMS & Ketamine Clinic Billing Services

TMS and ketamine clinics face billing problems that general psychiatry practices rarely see. TMS is billed in a long series of sessions that need prior authorization and proof that earlier treatments failed. Ketamine care is often paid in cash, and insurers handle it very differently from esketamine (Spravato), which has its own coverage path.

Mistakes are costly because each course of care involves many visits and expensive equipment or drugs. Westmont Revenue Partners connects TMS and ketamine clinics with vetted billing experts who understand treatment series, authorization steps, and drug billing, and who can support the full revenue cycle.

Who this is for

• Standalone TMS centers and psychiatry practices that added TMS
• Clinics offering ketamine or esketamine treatment
• Interventional psychiatry groups with multiple locations
• Physician-owned practices and clinics run by nurse practitioners
• Operators weighing insurance billing against cash-pay models

What gets billed

• Initial TMS motor threshold determination and treatment planning
• Daily TMS treatment sessions
• Repeat motor threshold determinations during a course
• Psychiatric evaluations before treatment starts
• Medication management visits
• Esketamine nasal spray sessions with observation
• Ketamine infusion visits where a payer covers them
• Monitoring and supervision during treatment
• Follow-up visits and maintenance treatment
• Prior authorization submissions and appeals

Commonly billed codes

Code	Type	What it covers
90867	CPT	First TMS treatment, including motor threshold work and planning
90868	CPT	Later TMS treatment sessions that deliver and manage the therapy
90869	CPT	Repeat motor threshold determination with a later TMS treatment
G2082	HCPCS	Medicare bundled code for a Spravato session at lower doses
G2083	HCPCS	Medicare bundled code for a Spravato session at higher doses
90791	CPT	Psychiatric diagnostic evaluation without medical services
90792	CPT	Psychiatric diagnostic evaluation with medical services
99214	CPT	Established patient office visit of moderate complexity

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in TMS and ketamine clinics

• Prior authorization for TMS. Most payers require proof of past treatments and a documented diagnosis before approving a course. Billers assemble the records and track approved session counts.
• Treatment series tracking. A TMS course can mean dozens of visits. Billers watch the number of approved sessions so claims are not denied halfway through.
• Billing 90867 and 90868 correctly. Different codes apply to the first session and to later sessions. Billers confirm the right code on each date and avoid repeating the first-session code.
• Motor threshold redetermination. The code for repeat threshold work is used only in certain cases. Billers check documentation and payer edits.
• Esketamine coverage differences. Medicare uses bundled codes for office-based sessions, while other payers may use a drug code plus an observation service. Billers check each plan and note that code sets change, so they review current-year updates.
• Ketamine infusion coverage. Many payers do not cover ketamine for depression. Billers help clinics set clear cash-pay policies, and explain this to patients before treatment.
• Buy-and-bill drug costs. Clinics may buy drugs up front and wait for payment. Billers track drug claims closely because denials hit cash flow hard.

How Westmont can help

• Matching you with vetted billing experts experienced in TMS and ketamine clinics
• End-to-end revenue cycle support, from authorization to payment posting
• Denial management and appeals for treatment series and drug claims
• Help with credentialing for physicians and advanced practice providers
• Guidance on separating insurance and cash-pay workflows

Frequently asked questions

What codes are used to bill TMS?

Three CPT codes cover most TMS work: 90867 for the first treatment with planning, 90868 for later sessions, and 90869 when threshold work is redone with a later session. Payers set their own rules on how often each can be billed, so check the policy before submitting.

Does insurance cover ketamine treatment?

Coverage varies a lot. Many payers do not cover ketamine for depression because it is used off label. Esketamine (Spravato) is different, since it is approved for certain uses and many plans cover it under a program. Verify benefits and explain costs to patients up front.

How is Spravato billed under Medicare?

Medicare generally uses bundled codes G2082 or G2083 depending on dose. They cover the drug, supervision, and observation time, and are meant for established patients. They should not be billed alongside an E/M visit on the same date. Check current-year Medicare updates.

Why was our TMS authorization denied?

Common reasons are missing records of past medication trials, incomplete rating scale scores, or a diagnosis that does not meet the plan's criteria. A biller can compare the denial to the policy, help your team fill gaps, and file an appeal.

Should a ketamine clinic accept insurance or stay cash-pay?

It depends on your services and payer mix. Insurance can widen access but adds paperwork and denials. Cash-pay is simpler but limits who can afford care. A billing expert can help you weigh the trade-offs before you decide.

Related billing services

• Psychiatry Billing
• Child & Adolescent Psychiatry Billing
• Pain Management Billing
• Addiction Medicine Billing
• Infusion Center Billing