Billing for Spravato® and TMS: What Every Mental Health Practice Needs to Know

Spravato® and TMS can transform lives — but only if your practice gets paid. Learn what makes billing for these advanced mental health treatments so tricky, and how to avoid costly mistakes.

Let’s talk about how TNT Healthcare Billing Solutions can help your practice maximize reimbursements and minimize headaches. 

Ready to strengthen your billing for Spravato® and TMS?

At TNT, we’ve developed proven workflows tailored specifically for the complexities of mental health billing. Our payer-specific SOPs ensure that authorizations are carefully tracked by both date and unit, and that documentation requirements are clearly defined and consistently met. We prioritize submitting clean claims the first time – under the correct provider, with the proper codes – to minimize denials and delays. 

When underpayments or denials do occur, we proactively appeal to recover every dollar owed. Most importantly, our approach allows your practice to stay focused on patient care while we manage the intricate billing processes behind the scenes.

How TNT Helps Mental Health Practices Stay Ahead

Even well-run practices can leave thousands on the table. Here’s where we see the most frequent revenue leakage:

  • Mismatched Credentials: Billing TMS mapping under a non-credentialed provider leads to costly denials.
  • Expired Authorizations: Many practices fail to track expiration dates and usage limits, unknowingly delivering services that won’t get reimbursed.
  • Documentation Gaps: Missing or incomplete session logs can delay payments, or worse, trigger recoupments months later.
  • Untracked Units: Failing to match approved units or visit counts can cause underpayments or lost revenue.
  • No Appeals Process: High-value claims are often underpaid or downcoded. Without a dedicated process to catch and appeal these errors, practices lose significant income.

Common Pitfalls (And How to Avoid Them)

Spravato® and TMS aren’t standard therapy sessions. They’re heavily regulated, high-value treatments that invite greater scrutiny from payers. Key complexities include:

Authorization Nuances
For Spravato®, approvals are often tied not just to the number of treatments but also to strict timelines. Missing a treatment window can void prior authorizations, leaving practices to absorb unreimbursed costs.

Specialty Coding
TMS requires specific CPT codes, like 90867, for treatment mapping. Billing under the incorrect provider type—such as a nurse practitioner instead of a psychiatrist—can result in denials or audits down the road.

Documentation Demands
These services demand detailed, time-based chart notes. Whether it’s monitoring logs for Spravato® or start/stop times for TMS, incomplete documentation can jeopardize reimbursements.

Modifiers and Place-of-Service Codes
With many practices offering hybrid models (telehealth plus in-office care), correct coding for service location is critical to prevent claim rejections.

Put simply, billing for Spravato® and TMS isn’t just about submitting claims—it’s about mastering the payer-specific rules that govern them.

Why Spravato® and TMS Billing Is Different

For mental health practices expanding into Spravato® (esketamine) treatments and Transcranial Magnetic Stimulation (TMS), the opportunity to offer advanced, life-changing care comes with a hidden challenge: billing. Unlike traditional therapy services, billing for Spravato® and TMS requires a deeper level of expertise – one that many practices underestimate until reimbursement issues arise.

At TNT Healthcare Billing Solutions, we’ve seen firsthand how these high-dollar services can either become a practice’s greatest asset or its biggest billing headache. 

To make it simple, we’ve boiled it down to the basics. Here’s what every mental health provider needs to know to maximize reimbursements and avoid costly mistakes.