CPT 00104: Anesthesia for Electroconvulsive Therapy
CPT code 00104 represents anesthesia services furnished during electroconvulsive therapy (ECT). Nationally, accurate use of this CPT code ensures appropriate classification of anesthesia care tied to a commonly performed psychiatric therapeutic procedure that requires brief general anesthesia or deep sedation. Correct coding affects claims processing, clinical documentation, and aggregated reporting for anesthesia utilization in mental health treatment.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication outlines who covers this service, common billing practices, and contextual clinical considerations tied to ECT anesthesia.
Readers will find a concise benchmarks and policy overview that covers standard clinical context for CPT code 00104, payer coverage considerations, and related anesthesia code relationships for peri-procedural classification. The report highlights where coding alignment matters for procedural setting designation (inpatient vs outpatient), and it summarizes related anesthesia service codes for comparative reference. Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 00104 describes anesthesia services provided for a patient undergoing electroconvulsive therapy. The service type is anesthesia for electroconvulsive therapy, and the typical site of service is an inpatient or outpatient procedural setting where electroconvulsive therapy is performed, such as a hospital operating room, procedure suite, or specialized psychiatric ECT suite.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with severe, treatment-resistant major depressive disorder is scheduled for a series of electroconvulsive therapy (ECT) treatments. The patient arrives at an outpatient hospital-based procedural suite or an ambulatory surgery center. Pre-procedure evaluation by anesthesia includes airway assessment, review of medications (particularly anticoagulants and psychotropics), NPO status verification, and informed consent for general anesthesia and airway management. On the day of treatment, the anesthesia provider administers intravenous induction agents, short-acting neuromuscular blockade to facilitate safe administration of the ECT stimulus, and appropriate monitoring (continuous ECG, pulse oximetry, capnography, noninvasive blood pressure). After the brief generalized seizure elicited by the psychiatrist, the anesthesia team manages airway support, reverses neuromuscular blockade as indicated, and monitors emergence in the post-anesthesia care unit (PACU) until the patient meets discharge criteria or is transferred for further observation. Typical sites of service are psychiatric hospitals, hospital-based operating rooms/procedural suites, and ambulatory surgery centers. The procedure is performed by credentialed anesthesiologists or certified registered nurse anesthetists (CRNAs) working with psychiatrists who administer the electrical stimulus.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual anesthesia — typically administered for emergency or unusual circumstances where general anesthesia is required but not usually used for the procedure | Use when ECT requires unplanned or unusually deep/general anesthesia beyond standard practice for procedural circumstances |
50 | Bilateral procedure | Use if documentation supports bilateral simultaneous procedures (rare for ECT; only if bilateral leads/technique explicitly documented and payer requires modifier) |
52 | Reduced services | Use when anesthesia time or services are intentionally reduced and documented (e.g., abbreviated session due to early termination) |
53 | Discontinued procedure | Use when anesthesia care is stopped because the procedure was aborted for documented clinical reasons |
56 | Preoperative management only | Use if the anesthesia provider only provided preoperative evaluation and did not provide intraoperative care for the ECT session |
62 | Two surgeons or co-surgeons (applies to anesthesia when separate surgeon responsibilities exist) | Rare for ECT; use only if billing rules or clinical documentation show concurrent attending-level responsibilities requiring this modifier for payer adjudication |
66 | Surgical team | Use when anesthesia services are part of a documented surgical team model that impacts billing assignment for the ECT session |
78 | Unplanned return to the operating/procedure room | Use when the patient requires an unplanned return to the procedure area requiring additional anesthesia for ECT-related complications |
AA | Anesthesia services performed personally by anesthesiologist | Use when an anesthesiologist personally performs the anesthesia care for the ECT session |
AD | Medical supervision by a physician; more than 4 concurrent anesthesia procedures | Use when an anesthesiologist supervises multiple CRNAs during concurrent ECT procedures and documentation supports supervisory role |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | Use when an appropriately credentialed non-physician practitioner provides anesthesia services under state law and payer policy allows modifier AS |
QK | Medical direction of two, three, or four CRNAs/AA by an anesthesiologist | Use when an anesthesiologist medically directs multiple CRNAs during ECT sessions; requires documentation of medical direction criteria |
QS | Monitored anesthesia care (MAC) service | Use when the service is billed as MAC rather than general anesthesia for an ECT session, if clinically appropriate and documented |
XU | Unusual non-overlapping service by the same physician | Use when distinct, separately identifiable anesthesia services are provided for the same patient on the same day and documentation supports non-overlap |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Primary specialty providing peri-procedural anesthesia for ECT sessions |
207LA0401X | Pain Medicine (Anesthesiology) | Relevant when anesthesiologists with pain medicine training provide peri-procedural management or sedation protocols for complex patients |
207LP2900X | Pediatric Anesthesiology | Applies when ECT is performed in pediatric patients and a pediatric anesthesiologist provides care |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L02.211 | Cutaneous abscess of abdominal wall | Less directly related to ECT; may appear in records when a patient has a comorbid skin infection requiring concurrent or prior surgical drainage under anesthesia, or as an unrelated diagnosis on the same encounter record |
L03.311 | Cellulitis of abdominal wall | Indicates active soft tissue infection that may alter anesthesia planning, antibiotic use, or timing of elective ECT sessions |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | Non-specific dermatologic diagnosis that can be present as comorbidity; may influence positioning, monitoring site selection, or infection control measures during ECT sessions |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00100 | Anesthesia for procedures on salivary glands, including biopsy | Related as an adjacent head/neck anesthesia code within the same anesthesia section; useful for cross-referencing anesthesia base units and regional practices |
00102 | Anesthesia for procedures involving plastic repair of cleft lip | Related as another head/neck anesthesia code for comparison of base unit valuation and billing conventions |
00103 | Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) | Related as another craniofacial/face procedure anesthesia code in the same coding family |
00120 | Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified | Related as a neighboring code in the anesthesia coding series for procedures of the head and ear region |
00124 | Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy | Related as part of the anesthesia code family covering ear procedures for crosswalk and auditing purposes |
00126 | Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy | Related as another procedural anesthesia code in the head/neck grouping |
00140 | Anesthesia for procedures on eye; not otherwise specified | Related as a comparison code within anesthesiology for periocular/cranial procedures |
00142 | Anesthesia for procedures on eye; lens surgery | Related for coding reference among anesthesia codes for ophthalmic procedures |
00144 | Anesthesia for procedures on eye; corneal transplant | Related as a specialty ophthalmic anesthesia code for cross-reference |
00145 | Anesthesia for procedures on eye; vitreoretinal surgery | Related as an anesthesia code in the ophthalmic subset used for comparative coding validation |
00147 | Anesthesia for procedures on eye; iridectomy | Related as an anesthesia code within the same anesthesia section for head/face procedures |
00148 | Anesthesia for procedures on eye; ophthalmoscopy | Related as an adjacent anesthesia code for head/ocular procedures |
00160 | Anesthesia for procedures on nose and accessory sinuses; not otherwise specified | Related as a nasal/sinus anesthesia code in the broader head and neck anesthesia family |
00162 | Anesthesia for procedures on nose and accessory sinuses; radical surgery | Related for comparison when significant airway or head/neck surgical complexity overlaps with ECT anesthesia considerations |
00164 | Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue | Related as another head/neck anesthesia code for coding alignment and auditing purposes |