Correct TMS billing doesn’t begin when the claim goes out. It begins with insurance verification, Prior Authorization, accurate documentation, and using the right CPT code for each individual session.
A practical workflow looks something like this: Eligibility, then Prior Authorization, then Treatment, then Documentation, then Coding, then Claim Submission, then Payment, then AR Follow-Up.
At Finnastra, we manage TMS billing as one connected revenue cycle rather than a series of separate steps. That connection is what helps practices reduce avoidable denials and catch problems before they ever reach AR.
Before treatment begins, a practice needs to confirm more than whether the patient’s insurance is simply active.
Worth verifying: TMS coverage under the patient’s specific plan, provider and facility network status, Prior Authorization requirements, diagnosis and medical necessity criteria, deductible, copay, and coinsurance amounts, and the approved number of treatment sessions.
This is where a lot of billing problems start. A patient can have active behavioral health coverage and still need specific documentation, authorization, or network conditions before TMS is actually payable.
Our TMS Billing Services are built to identify these requirements before treatment starts, which cuts down significantly on preventable denials later.
TMS typically involves a series of repeated sessions, which makes authorization tracking especially important. The billing team should keep an eye on approved CPT codes, the number of authorized sessions, effective dates, the rendering provider, treatment location, and reauthorization requirements.
If authorization expires midway through a course of treatment, several claims can be affected before anyone notices. Finnastra tracks authorization validity alongside treatment activity, so practices aren’t relying on manual reminders or discovering an expired approval only after claims start coming back denied.
Three CPT codes sit at the center of most repetitive TMS billing workflows.
90867
Used for the initial treatment planning session, including initial mapping and motor threshold determination.
90868
Used for subsequent routine TMS treatment delivery and management.
90869
Used when motor threshold is re-determined during a later treatment session.
The billing code should reflect exactly what happened during that visit. It sounds obvious, but plenty of denials start when scheduling labels, clinical notes, and claim codes don’t line up with each other.
As a specialized TMS Billing Company, Finnastra reviews coding against the underlying documentation and authorization rather than relying solely on the appointment type on the schedule.
Accurate coding alone isn’t enough. The medical record needs to support the diagnosis and medical necessity, the treatment plan, the specific session performed, provider involvement, clinical response where applicable, and motor threshold re-determination whenever that’s what’s being billed.
Payers often have their own specific coverage or documentation requirements on top of that. This is exactly why billing and clinical documentation can’t operate in separate silos. When our team spots a documentation gap, the goal is to resolve it before the claim goes out, not after it comes back denied.
A claim can pass through the clearinghouse without a hitch and still create a revenue problem down the line. After submission, practices should keep watching claim acceptance, payer adjudication, payment amount, denials, underpayments, patient responsibility, and outstanding AR.
Underpayments are especially easy to miss because the claim often just shows up as “paid.” At Finnastra, payment posting is tied directly to reimbursement review, so unexpected payer reductions get flagged instead of quietly accepted.
Picture a patient approved for a full course of TMS treatment. The first several sessions get billed correctly. Treatment keeps going, but the authorization hits its limit before the clinical team realizes additional approval is needed.
The patient still receives treatment. The claims still get denied.
The issue here isn’t coding at all. It’s a breakdown between authorization tracking, scheduling, and billing, three things that should never operate independently. This is exactly why Finnastra manages the TMS revenue cycle as one connected workflow instead of a handful of disconnected tasks.
A well-run TMS practice has clear ownership at every stage of the process: Insurance Verification, then Authorization, then Treatment, then Documentation, then Coding, then Claim Submission, then Payment Review, then AR Follow-Up.
The clinical team shouldn’t be chasing down payer rules. The front desk shouldn’t be left interpreting authorization details on its own. And the billing team shouldn’t be piecing together what happened after the fact. Finnastra helps practices build that separation of responsibilities while keeping the whole process connected end to end.
Our TMS Billing Services cover the full revenue cycle: eligibility and benefits verification, Prior Authorization and tracking, TMS coding review, claim submission, payment posting, denial management, appeals support, underpayment review, AR follow-up, and reporting and collections monitoring.
The objective is straightforward: fewer preventable denials, cleaner claims, faster follow-up, and real visibility into what the practice is actually collecting.
The strongest TMS billing process doesn’t start with claim submission. It starts with verifying coverage, securing the right authorization, documenting treatment correctly, and making sure every claim actually reflects what happened.
That’s where specialized support makes a real difference. Finnastra helps TMS practices connect front-end verification, authorization, billing, and AR into one revenue cycle, so fewer problems ever reach the denial stage in the first place.
