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We’re expanding rTMS prior authorization to Medicare HMO and PPO Blue
November 1, 2019

This article is for primary care providers, behavioral health providers, and facilities caring for our members

Effective January 1, 2020, we’ll require prior authorization for repetitive transcranial magnetic stimulation (rTMS) services for Medicare HMO and PPO Blue members. Prior authorization will apply to these CPT codes when performed in an outpatient setting:

  • 90867
  • 90868
  • 90869

We already require prior authorization for this service for our commercial HMO and POS plan members.

How to request prior authorization
We suggest you complete and fax the Repetitive Transcranial Magnetic Stimulation Request Form (Mass Collaborative form) to: 1-888-641-5199.

We’ll review your request and make a medical necessity determination, based on criteria described in our medical policies. We’ll fax and mail our decision to you.

Resources

Questions?
If you have any questions, please call Behavioral Health Coordination at
1-800-524-4010. As always, thank you for the care you provide to our members.

MPC_100319-1P-1-ART

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