A199 – Initiation of rTMS for treatment resistant depression
OHIP General Listings Code · Schedule of Benefits
Initiation of repetitive transcranial magnetic stimulation (rTMS) for treatment resistant depression is an assessment rendered by a specialist in Psychiatry where the physician spends a minimum of 30 minutes (consecutive or non-consecutive) in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient. The physician must be available to intervene in a timely fashion for the duration of the initial therapy session to manage adverse reactions or the service is not eligible for payment.
When to Use
- Bill A199 when a psychiatrist initiates a course of rTMS for a patient with documented treatment-resistant depression, spending at least 30 minutes in direct assessment and planning.
- Use A199 for the initial rTMS assessment, ensuring the physician is immediately available to manage potential adverse reactions during the first treatment session.
- A199 is appropriate when the physician determines the initial rTMS treatment parameters, including motor threshold and coil placement, as part of the 30-minute direct patient contact.
Common Pitfalls
- Billing A199 when the physician is not immediately available to manage adverse reactions during the initial rTMS session will lead to rejection.
- Including time spent on other separately billable procedures or interventions within the 30-minute minimum for A199 will result in claim denial.
- Submitting A199 for patients without a documented diagnosis of treatment-resistant depression is a common reason for rejection.
Billing Tips
- Ensure the 30-minute minimum for A199 is exclusively direct patient contact, excluding any indirect time or concurrent patient care.
- A199 cannot be billed with K630 on the same day, as K630 is an extension of a consultation, not an initiation assessment like A199.
Effective: April 1, 2026
Psychiatry
Assessment
Minimum of 30 minutes (consecutive or non-consecutive) in direct contact with the patient, exclusive of time spent rendering any other separately billable intervention to the patient.
The physician must be available to intervene in a timely fashion for the duration of the initial therapy session to manage adverse reactions or the service is not eligible for payment.
A199 is only eligible for payment for a patient with an established diagnosis of treatment resistant depression, documented in the patient’s medical record.
Indirect time (when the patient is not present) may not be included towards the minimum time requirement.
Concurrent time (with more than one patient) may not be included towards the minimum time requirement.
A199 is not listed in Appendix J and is therefore not eligible for virtual care delivery.
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