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February 1, 2026 · 8 min read
Documenting TMS sessions in a way payers actually accept
The seven fields that show up in every favorable payer review — and the three that show up in every denial.
By Faisal Rafiq, MD
Payer documentation isn't about volume. It's about the right seven fields, in the right place, every session.
The seven that work
- Session number out of the planned course.
- Protocol (frequency, intensity, pulse count, train pattern).
- Motor threshold reference and any retitration.
- Tolerability and adverse events.
- A measurement-based score (PHQ-9 weekly).
- Clinician attestation, signed at the time of service.
- Coil position and any adjustment.
The three that trigger denials
Missing MT reference, missing PHQ-9 trend, and missing attestation timestamp. Fix those three and most reviewable denials disappear.