Medicare AdvantageBilling CodesMedium impact
MA07.035g, Therapeutic Transcranial Magnetic Stimulation (TMS)
Independence Blue Cross·Psychiatry·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA07.035g to add two new CPT codes (0997T, 0998T) for Transcranial Magnetic Stimulation (TMS) treatment effective January 1, 2026. The policy reinforces coverage criteria for TMS in Medicare Advantage members aged 15+ with severe major depressive disorder who have failed medication trials or demonstrate intolerance to psychopharmacologic medications. Billing teams must recognize and apply the new codes when TMS services meet all documented medical necessity criteria.
Action Required
By December 15, 2025: Billing team must update billing system and claim submission software to recognize CPT codes 0997T and 0998T for TMS services under MA07.035g. Ensure prior authorization workflows require documentation of: (1) severe major depressive disorder diagnosis (ICD-10 F32.2 or F33.2), (2) psychiatrist referral with face-to-face examination, (3) failure of at least one adequate antidepressant medication trial OR documented intolerance, and (4) absence of absolute contraindications (implanted magnetic-sensitive devices ≤30 cm from TMS coil). Train providers and billing staff on the expanded code set and reinforced behavioral health criteria. Update encounter templates to capture required documentation elements. Beginning January 1, 2026, submit claims for TMS with the appropriate code (0997T, 0998T, or established 90867/90868/90869) along with supporting documentation. Claims submitted without evidence of meeting all medical necessity criteria will be denied.