Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57072 (Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57072: Billing and Coding: Transcranial Magnetic Stimulation (TMS) in the Treatment of Adults with Major Depressive Disorder (Billing and Coding, effective 2023-07-06)
- Covered ICD-10-CM codes
- 2
- 1 group
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 3
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| F32.2 | — |
| F33.2 | — |
Procedure codes: 90867, 90868, 90869.
Coverage indications, limitations and medical necessity
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
Transcranial Magnetic Stimulation (TMS) is FDA approved for the treatment of depression and obsessive-compulsive disorders. 1-3 It is a non-invasive procedure that uses pulsed magnetic fields to induce an electric current in a localized region of the cerebral cortex. 4-7 An electromagnetic coil is placed on the scalp inducing a focal current into the brain that temporarily modulates cerebral cortical function. A capacitor discharge provides electrical current in an alternating on/off pulse. Based on stimulation parameters this may be adjusted to alter the excitability of the targeted structures in specific cortical regions. 8 The electromagnetic current parameters include cranial location, frequency, strength, width, and volume dependent on the motor threshold that is individualized for each patient. 1,2
TMS is delivered daily in an outpatient setting without anesthesia or analgesia for up to six weeks and there are no restrictions related to activities before or after treatment (e.g., driving, working, operating heavy machinery). 9
Definitions
Major Depressive Disorder: The diagnosis that is based on the definition in the current Diagnostic and Statistical Manual of Mental Disorders (DSM). It is based on symptoms, characteristics, and requirements that are needed in order to be diagnosed with depression.
Major Depressive Disorder – Severe: A subcategory of major depressive disorder as differentiated within the DSM manual from mild, moderate, and severe. For example: “The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.” 10
Failure of a trial of a pharmacological agent: The failure of one or more psychopharmacological medications that are administered at both an adequate dose and adequate duration that are consistent with the FDA label and with a duration that would elicit a favorable response. 9,11-13
Intolerance of a psychopharmacologic agent: Intolerable side effect(s) that are not expected to diminish or resolve with continued administration of the medication. 5,14,15
Motor Threshold (MT) Intensity: The minimum stimulator setting that induces an observable motor response when applied to the patient. 1
Frequency: The number of pulses delivered per second, measured in Hertz (Hz). 1
Magnetic Field Strength: The measurement of voltage induced to the identified area. 1
Pulse Width: The duration of time from the peak of a pulse to the peak of the next pulse. 1
Stimulation Volume: The region of cortical tissue that is stimulated based on the Motor Threshold identified for the individual patient. 1
Covered Indications
TMS of the brain for severe MDD, single or recurrent episode, is considered medically reasonable and necessary for up to six weeks 3,5,6,16-19 when the following criteria are met:
• The patient has a confirmed diagnosis of severe MDD as defined by the current DSM.
AND
• The patient has demonstrated a failure of one or more trials of a pharmacological medication and/or demonstrates an intolerance to psychopharmacologic medications as defined in the definition section above.
AND
• The order for TMS procedure is written by a psychiatrist (MD or DO), who has examined the patient face to face and reviewed the record. 20
Limitations
The following is considered an ABSOLUTE CONTRAINDICATION:
The presence of a medically implanted magnetic-sensitive device or other implanted metal items including, but not limited to, a cochlear implant, implanted cardiac defibrillator (ICD), pacemaker, vagus nerve stimulator (VNS), metal aneurysm clips/coils, staples, or stents, that are located less than or equal to 30 cm from the TMS magnetic coil. 1,6,15
The following are considered RELATIVE CONTRAINDICATIONS:
• The presence of a seizure disorder or any history of seizures (except those induced by Electroconvulsive therapy [ECT] or isolated febrile seizures in infancy without subsequent treatment or recurrence).
• The presence of acute or chronic psychotic symptoms or disorders in the current depressive episode.
• The presence of any neurological conditions including epilepsy, cerebrovascular disease, dementia, increased intracranial pressure, history of repetitive or severe head trauma, or primary or secondary tumors in the central nervous system.
The following is considered not medically reasonable and necessary:
All other uses of TMS, including the use of TMS for OCD. 7,12,20-23
Provider Qualifications
Services will be considered medically reasonable and necessary when all aspects of care are within the scope of practice of the provider’s professional licensure, when performed according to the supervision requirements per state scope of practice laws, and when all procedures are performed by appropriately trained providers in the appropriate setting.
Notice: Services performed for any given diagnosis must meet all the indications and limitations stated in this LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
Summary of evidence (opening)
This summary of evidence focuses on the use of TMS in the treatment of MDD and TMS in the treatment of OCD to determine whether the evidence is sufficient to draw conclusions about improved health outcomes for the Medicare population. In general, improved health outcomes of interest include patient quality of life and function.
In addition to reviewing evidence presented at a Multi-jurisdictional CAC Meeting and literature submitted with reconsiderations, a literature search was conducted using the following key words and phrases: TMS and OCD; TMS treatment for OCD; RCT of OCD TMS; OCD for deep transcranial magnetic stimulation (dTMS); Non-invasive/non-pharmacological OCD/depression treatment; and TMS as OCD treatment; scoring of Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Scale (MARDS) treatment parameters; DSM mild, moderate, severe depression. Along with various association guidelines. The highest level of evidence consisting of large randomized controlled trials (RCTs), multi-site RCTs, peer reviews and society endorsements were followed.
Clinical Trials
Rush et al 16 reviewed the protocol implemented by the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) that include a RTC that began with 3,671 patients who would receive the first of four levels of treatment beginning with medication. At any time during the protocol, if a patient achieved remission, they could then opt to be followed in a long-term naturalistic review that would last 12 months. The study began with 41 clinical sites consisting of patients between 18-75 years of age, diagnosed with MDD, and not previously exposed to any treatment protocol in the first and second treatment steps.
The contractor cites 85 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2022-12-11
- MCD version
- 33
- Derived from
- L32055
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Novitas Solutions, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L34998 cover?
Transcranial Magnetic Stimulation (TMS) is FDA approved for the treatment of depression and obsessive-compulsive disorders. 1-3 It is a non-invasive procedure that uses pulsed magnetic fields to induce an electric current in a localized region of the cerebral cortex. 4-7 An electromagnetic coil is placed on the scalp inducing a focal current into the brain that temporarily modulates cerebral cortical function. A… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34998 apply to?
Novitas Solutions, Inc. applies it to Medicare claims in AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34998?
The companion billing and coding article A57072 lists 2 ICD-10-CM codes in 1 group that support medical necessity and 1 that do not; the first 2 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34998?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.