Medicaid Update – New York State Medicaid Coverage of Therapeutic Transcranial Magnetic Stimulation
IMPACTED PLANS: Medicaid, SNP, HARP, CHP, QHP, EP, Gold, and Gold Care
TO: Behavioral Health Providers
Effective November 1, 2025, Therapeutic Transcranial Magnetic Stimulation (TMS) is a covered benefit under Current Procedural Terminology (CPT) codes “90867”, “90868” and “90869” for treatment resistant Major Depressive Disorder (MDD).
Transcranial Magnetic Stimulation must be performed by a qualified psychiatrist with specialized training and certification for treating persistent depressive disorder when other treatments fail. Treatment resistance is defined as two trials of a therapeutic dose of two different antidepressants.
These services are covered for the following conditions when first-line treatments have been unsuccessful:
| Diagnosis Code | Diagnosis Code Description |
|---|---|
| F32.2 | MDD, single episode, severe without psychotic features. |
| F33.2 | MDD, recurrent severe without psychotic features. |
Note: Prior authorization is required, for more information see link: https://metroplus.org/providers/provider-resources/provider-authorization.
TMS is not a first line therapy for depression and is not covered for certain conditions. Reimbursement for Medicaid is available for:
- Medicaid members aged 18 and older
- Members diagnosed with treatment resistant MDD
| CPT Code | CPT Code Description |
|---|---|
| 90867 | Therapeutic repetitive TMS initial planning visit; includes initial procedures such as cortical mapping, motor threshold determination, delivery, and management. |
| 90868 | Therapeutic repetitive TMS treatment; subsequent delivery and management, per session. |
| 90869 | Re-determination of motor threshold during TMS. This code is used for subsequent assessments of the motor threshold, which is the minimum intensity of electrical pulses required to elicit a desired response in brain activity. |
Note: CPT codes “90867”, “90868” and “90869” may not be billed on the same date-of-service.
For more information, please refer to this Medicaid update regarding TMS at https://www.health.ny.gov/health_care/medicaid/program/update/2025/no07_2025-07.htm.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].