The Centers for Medicare & Medicaid Services (CMS) established two dedicated Healthcare Common Procedure Coding System (HCPCS) codes for the TOMAC system effective October 1, 2024. ^[1] Code E0743 is billed per unit, meaning two units are required for bilateral therapy, and staff must not assume the code descriptor covers both legs automatically. ^[2] Payer policies commonly require documentation that the patient is refractory to medications or unable to tolerate them, such as gabapentin, dopamine agonists, or opioids. ^[3] The TOMAC system is classified as durable medical equipment (DME) and is priced as a capped rental rather than a one-time supply or implanted neurostimulator. ^[4] According to CAQH, eligibility runs 96% electronically, but prior authorization is only 40% fully electronic, and attachments sit at 24% in medical spaces. ^[5] CMS-0057-F requires payers to expose FHIR APIs, including for prior authorization, by January 1, 2027, which will convert execution from brittle screen-scraping into a clean engineering problem. ^[6] HFMA reported that up to 65% of denied claims are never reworked because there are more defensible denials than biller-hours available to defend them. ^[7] Most RCM AI tools function as coordination systems that recommend actions, score denials, and draft appeal letters, but they route the final task back to a person to log in and finish the work. ^[8]