Prior Authorization
Aetna Prior Authorization for CPT 90868
Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment including initial, subsequent, and motor threshold re-determination sessions, and unlisted psychiatric service · Standard commercial plans
Source
Aetna Behavioral Health Precertification ListNot 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 90868 as requiring precertification for applicable Aetna commercial plan members.
Documentation checklist
- ✓Completed behavioral-health precertification request
- ✓Clinical records supporting the requested TMS service
Submission channels
Phone
1-888-632-38622026 Medicare rate for CPT 90868
CPT 90868 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 90868 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 90868?
- Yes. Aetna requires prior authorization for CPT 90868 (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 90868?
- Completed behavioral-health precertification request; Clinical records supporting the requested TMS service
- What if Aetna denies the PA for CPT 90868?
- 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 90868 prior authorization by payer
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