CPT Code for ECT: 90870 Billing, Anesthesia and Documentation

By Awais Afzal, Healthcare Operations & Data Analyst · Published April 5, 2026 · Updated October 14, 2026

The CPT code for ECT is 90870, which reports the treatment itself, including the necessary monitoring. Anesthesia has its own code, 00104, and whether anyone is paid separately for it depends on the payer, the setting and who gives it. Confirm each payer's policy before you build the claim.

Picture a hospital-based psychiatry unit that treats a patient on Tuesday. The psychiatrist’s claim goes out with 90870. The anesthesia group sends 00104. The hospital sends its own facility claim. Two of the three come back denied for different reasons, and nobody can say which payer rule applied.

This guide walks through each piece of that claim. It stays on ECT. For the wider code set, see our guide to coding and billing for mental health services. Every payer rule below comes from a policy we read, and we name the payer and the date. Where policies disagree, we say so.

What the CPT code for ECT reports

CPT 90870 reports electroconvulsive therapy, with the monitoring that goes with it. A national payer’s policy lists 90870 as the ECT treatment code, with its necessary monitoring included, and lists 00104 as the anesthesia code for ECT (Aetna Clinical Policy Bulletin 0445, reviewed July 2026). We describe the codes in our own words because the AMA owns the official CPT wording. Check the current CPT book when you build your charge master.

The practical point is that one treatment day can produce three claims: the psychiatrist’s professional claim, an anesthesia claim, and a facility claim. Each follows a different rule. Mixing those three up is an easy way to create a denial, and it has nothing to do with the code 90870 itself.

What 90870 includes and what it leaves out

Think of 90870 as the psychiatrist’s treatment service. The monitoring that is part of delivering the treatment goes with it, so it is not a second line item. Everything else around the treatment is billed under its own rule. The table shows where each piece usually goes.

Sources: Aetna Clinical Policy Bulletin 0445 (reviewed July 2026); Optum reimbursement policy 2017RP510A (reviewed September 2025); WPS local coverage article (2010); Louisiana Healthcare Connections payment policy LA.PP.013 (reviewed December 2024). Row 5 is our reading of the modifier 25 rule below.

A claim that tries to bill the evaluation, the treatment and the anesthesia on one professional claim is the most common structural error we would look for. Split them by who performed the work.

Anesthesia for ECT: 00104 and who gets paid

00104 reports anesthesia for ECT, but who gets paid for it is not the same everywhere. Two published policies we read give different answers, so the safe rule is to read each payer’s policy rather than assume a separate payment.

Sources: WPS (2010); Optum (2025); Aetna (2026); CMS (2026); Memorial Hermann Health Plan (2021). Payment percentages are from one plan’s policy and are not a national rule.

The honest conclusion is that “the anesthesiologist bills 00104 separately” is true for some payers and not for others. The Optum policy reads the other way when the facility bills the ECT under revenue code 0901. Ask each payer who is allowed to bill 00104, on which form, and with what modifier. Get the answer in writing. Our anesthesia billing guide covers time units and modifiers in general.

One more detail from the Medicare contractor article: it limits 00104 to a single unit. It is a 2010 document, so confirm the current contractor policy before you rely on it.

Medical necessity and diagnosis coding

Medical necessity for ECT comes from each payer’s policy, and diagnosis lists differ. The table shows one national payer’s list as an example. It is not a rule that applies to every plan.

Source: Aetna Clinical Policy Bulletin 0445, Electroconvulsive Therapy (reviewed July 29, 2026). Other payers publish different lists.

The same policy also asks for more than a diagnosis. Members must meet at least one of several conditions, such as not responding to adequate medication, being unable to tolerate effective medication, or having responded to ECT before. It also lists catatonia as its own qualifying condition. So a schizophrenia code alone does not carry the claim. Match the diagnosis on the claim to the clinical reason in the chart. Our ICD-10 codes for mental health guide covers diagnosis coding in more depth.

Medicare adds a limit of its own. National Coverage Determination 160.25 states that multiple-seizure electroconvulsive therapy is not covered by Medicare as reasonable and necessary (CMS Medicare Coverage Database, version effective April 2003). The page we read marks that version as older, so check the current text before you cite it.

Prior authorization and treatment frequency

Prior authorization rules for ECT are set by each plan, and the number of sessions allowed varies. We did not find a single national figure, so build your authorization tracking around each payer’s own policy.

What the sources we read do say is limited. Aetna’s bulletin notes that acute courses are typically given two or three times per week, with daily treatment possible in urgent situations, and that maintenance sessions usually start weekly and then taper. It also says that more than 20 sessions in a treatment series is rarely medically necessary. Those are one payer’s clinical statements, not billing limits for every plan. Optum’s policy asks for authorization or notification of an acute inpatient stay when the member’s plan requires it for inpatient ECT.

A practical way to handle this is a one-page sheet per payer: whether authorization is needed, how many sessions it covers, how to extend a series, and how to request maintenance treatment. Our prior authorization guide explains how to build that workflow.

Place of service and the facility claim

The place of service on the professional claim must match where the treatment actually happened. Aetna’s bulletin notes that ECT is most often given as an inpatient service but may be given in an outpatient facility with the right treatment, recovery and emergency capability. The right code depends on the facility and the payer.

The CMS place of service list (CMS Place of Service Code Set, page modified February 2026) defines the main options. POS 11 is the office. POS 21 is an inpatient hospital, which CMS describes as a hospital other than psychiatric. POS 22 is the on-campus outpatient hospital. POS 19 is the off-campus outpatient hospital. POS 24 is a freestanding ambulatory surgical center. Because POS 21 excludes psychiatric hospitals, a psychiatric facility may need a different code, so confirm that with the payer.

We could not verify the old claim that billing ECT in POS 11 is always non-compliant and triggers payer investigations. What we can say is that an office setting would be hard to defend if the treatment was not given there. Bill the place where the patient was treated, and make sure the same location appears on the anesthesia and facility claims.

On the facility side, both the Medicare contractor article and the Optum policy tie ECT to revenue code 0901. The Optum policy says facility claims must use it with 90870 and 00104, and it applies the rule to CMS-1500, UB-04 and electronic claim formats. The contractor article says inpatient psychiatric facility units should equal the number of ECT treatments in the stay. Our medical billing services team builds claim edits around these facility rules.

Same-day E/M and modifier 25

A same-day evaluation and management (E/M) service can be billed with ECT only when it is significant, separately identifiable work, and it needs modifier 25. Routine pre-treatment checks are part of the procedure.

A Louisiana Medicaid managed care plan’s payment policy (Louisiana Healthcare Connections LA.PP.013, reviewed December 2024) describes the rule well. It says the E/M must go beyond the usual work before and after the procedure. It also says the decision to perform a minor procedure is part of that procedure and is not billed as an E/M. That policy is about minor procedures, so we use it as a guide to the principle, not as an ECT rule. Your own payer’s policy comes first.

In practice, a psychiatrist who evaluates a new medical problem on the same day, such as a medication review unrelated to getting ready for the treatment, may have a supportable E/M. A routine check that the patient is ready for anesthesia does not. We removed the old post’s example of a specific hospital E/M code with modifier 25, because we could not verify it for ECT. Use whichever code the documentation supports. For the wider rule, see our guide to modifiers 25 and 59.

Documentation that supports the claim

The record has to show why ECT was prescribed and that the treatment happened. The Medicare contractor article says documentation must be in the medical record and that missing documentation leads to denial.

That article lists what the record should hold: a history and physical, a psychiatric diagnosis, the evaluation findings, and a record of the procedure. Progress notes should show the response or non-response and the continued need for ECT. Payers like Aetna add their own clinical criteria, so the chart should speak to them directly.

• The reason ECT is being used: failed or unsuitable medication, a prior response to ECT, or the urgency of the situation.
• Which treatment in the series this is, and the date and place of service.
• Who gave the treatment and who gave the anesthesia, with their credentials.
• The procedure record from the treatment room. Many teams also capture stimulus settings, seizure duration and electrode placement. Ask each payer which of these it expects.
• Anesthesia start and stop times, if the anesthesia claim uses time units.
• Response notes after each treatment or at set intervals.

Those items give a reviewer the story of the claim. They also give your billers what they need to catch a missing field before submission.

Common ECT denials and a pre-bill check

Three problems are worth checking first: a mismatch between the three claims, a missing authorization, and a diagnosis that does not match the payer’s list.

Date, place or provider mismatch

If the psychiatrist, the anesthesia group and the facility submit different dates of service or places of service, one or more will fail. We recommend a hard stop before submission that compares the date, place, patient details and diagnosis across all three claims.

Anesthesia paid to the wrong party

If the payer bundles 00104 into the facility payment, a separate anesthesia claim will be denied or recouped. Check the payer policy and the facility contract before the anesthesia group bills.

Medical necessity denials

Appeal with the medication history, the clinical reason, and the payer’s own published policy. Our denial management services team works these appeals for behavioral health claims.

If you handle claims for several providers, a practice management system can help here. A practice management system that tracks claims by stage gives each claim an owner and runs data-completeness checks before submission, so a missing date or diagnosis is flagged before it reaches the payer. It is a claim-centred tool, not an EHR.

Where ECT fits in behavioral health billing

ECT billing is part of a larger behavioral health revenue cycle, and the same habits that protect it apply to therapy and medication management. If your team also bills psychotherapy and psychiatric visits, our page on billing psychiatric procedures like ECT and the rest of behavioral health shows how we approach the whole cycle.

Our team works inside your existing EHR (for example PrognoCIS, eClinicalWorks or athenahealth). We put a Business Associate Agreement in place before accessing patient data. You can see how coding in this area compares with other psychiatric codes in our mental health CPT codes guide.

Our recommendations

1. Keep one rules sheet per payer. For each major payer, record who may bill 90870, who may bill 00104, the modifier and form to use, whether authorization is required and the session limits. Re-read each sheet once a year.
2. Settle the anesthesia question before the first treatment. Ask the payer and check the facility contract. One party should bill 00104, and everyone should know who.
3. Compare all three claims before submission. Dates, place of service, patient details and diagnosis should match across the psychiatrist, anesthesia and facility claims.
4. Chart the clinical reason in plain words. A clear note on why medication did not work, or could not be used, is the best protection against a medical necessity denial.
5. Do not add an E/M by habit. Bill a same-day E/M only when the note shows separate work. Train clinicians to write the two notes separately.
6. Review a sample of denied ECT claims each quarter. Group the denials by cause. If the same cause appears twice, change the template or the front-end check.

Bottom line

The CPT code for ECT is 90870, and the rest of the claim depends on who did what, where and for which payer. Keep the treatment, the anesthesia and the facility charges on their own claims, confirm each payer’s rules in writing, and match the chart to the payer’s criteria. If your team wants help working the denials you already have, our denial management services team can review them, or you can talk to our team about your process.

Frequently asked questions

Does the CPT code for ECT include anesthesia?

No. 90870 reports the treatment with its necessary monitoring. Anesthesia is reported with 00104. Whether that anesthesia is paid separately varies: one Medicare contractor article and one national payer’s policy we read bundle it in some situations. Check each payer’s policy and the facility contract.

Can a nurse practitioner bill 90870?

It depends on the payer and the state. One Medicare contractor’s policy limits 90870 to MD or DO physicians. Other payers and states may differ, and hospital privileges also matter. We could not find a rule that applies everywhere, so confirm with each payer and your state board before assigning the claim.

How many ECT sessions per week will a payer cover?

There is no single national limit that we could verify. Aetna’s bulletin says acute courses are typically given two or three times per week and that more than 20 sessions in a series is rarely medically necessary. Those are clinical statements from one payer. Check your plan’s authorization terms.

What place of service do I use for ECT?

Use the place where the patient was treated. CMS lists POS 21 for an inpatient hospital, POS 22 for an on-campus outpatient hospital and POS 24 for an ambulatory surgical center. Psychiatric hospitals may use a different code. Confirm with the payer, and keep the anesthesia and facility claims consistent.

Can I bill an E/M with 90870?

Only when the E/M is significant and separately identifiable from the pre- and post-work of the procedure, and then with modifier 25. A routine check before treatment is part of the procedure. Keep separate notes so a reviewer can see two different services.

Does Medicare cover multiple-seizure ECT?

No. National Coverage Determination 160.25 says multiple-seizure ECT is not reasonable and necessary and is not covered by Medicare. The version we read took effect in April 2003 and is marked as older, so check the current page. Your payer may have its own position.

Sources

1. Electroconvulsive Therapy, Clinical Policy Bulletin 0445 — Aetna (2026)
2. Local coverage article L30493 (PSYCH025), Electroconvulsive Therapy — WPS via CMS Medicare Coverage Database (2010)
3. Reimbursement policy 2017RP510A, Electroconvulsive Therapy — Optum (United Behavioral Health) (2025)
4. National Coverage Determination 160.25, Multiple Electroconvulsive Therapy — CMS Medicare Coverage Database (2003)
5. Place of Service Code Set — CMS (2026)
6. Anesthesiologist Assistants (AAs) — CMS (2026)
7. Anesthesia Reimbursement Policy (Medicare Advantage) — Memorial Hermann Health Plan (2021)
8. Clinical Validation of Modifier 25, LA.PP.013 — Louisiana Healthcare Connections (posted by Louisiana Department of Health) (2024)