What documentation does Aetna require for CPT 90867?

Completed behavioral-health precertification request; Clinical records supporting the requested TMS service

What if Aetna denies the PA for CPT 90867?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Aetna Prior Authorization for CPT 90867

Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment including initial, subsequent, and motor threshold re-determination sessions, and unlisted psychiatric service · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified May 9, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Aetna Behavioral Health Precertification List

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Aetna's behavioral-health precertification list includes transcranial magnetic stimulation code 90867 as requiring precertification for applicable Aetna commercial plan members. The behavioral-health list is linked from Aetna's current provider precertification resources and remains the source for behavioral-health service authorization checks.

Documentation checklist

✓Completed behavioral-health precertification request
✓Clinical records supporting the requested TMS service

Submission channels

Phone

1-888-632-3862

2026 Medicare rate for CPT 90867

CPT 90867 is not priced under the 2026 Medicare Physician Fee Schedule (status C) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT 90867 code page for pricing detail.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Completed behavioral-health precertification request, Clinical records supporting the requested TMS service.
3Submit via phone, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 90867?: Yes. Aetna requires prior authorization for CPT 90867 (Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment including initial, subsequent, and motor threshold re-determination sessions, and unlisted psychiatric service) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT 90867?: Completed behavioral-health precertification request; Clinical records supporting the requested TMS service
What if Aetna denies the PA for CPT 90867?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Aetna PA lookups

CPT 90834 CPT 90837 CPT 90792 CPT 90847 CPT 90791 CPT 90832 CPT 97161 CPT 93000

All Aetna prior-authorization requirements →

CPT 90867 prior authorization by payer

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