Prior Authorization
Humana 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
Data pending source-document linkage. Verify against Humana's current clinical policy before submission.
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
Behavioral health - Transcranial magnetic stimulation (TMS)
Documentation checklist
- ✓Clinical notes
2026 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: Clinical notes.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 90868?
- Yes. Humana 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 Humana require for CPT 90868?
- Clinical notes
- What if Humana 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 Humana PA lookups
CPT 90868 prior authorization by payer
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