Summary & Overview
CPT 90870: Electroconvulsive Therapy to Induce Seizure
CPT code 90870 designates the application of electric current to the brain to induce a seizure or series of seizures as a therapeutic intervention for certain mental disorders. Nationally, this code represents a specialized psychiatric procedure—electroconvulsive therapy (ECT)—that requires multidisciplinary staffing, monitored anesthesia, and a controlled clinical environment. It matters because ECT remains an important option for treatment-resistant depression, catatonia, and other severe psychiatric conditions, with implications for coverage policies, utilization management, and facility preparedness.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, typical care settings, and the practical coding label for claims. The publication highlights benchmarking and payer coverage patterns where available, summarizes relevant policy considerations and claim administration elements, and orients clinicians and billing staff to the national coding designation for ECT. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 90870 describes a procedure in which the provider applies an electric current to the patient's brain to produce a seizure or series of seizures for the purpose of alleviating symptoms of various mental disorders. This procedure is a form of electroconvulsive therapy (ECT) delivered by trained psychiatric and anesthesia teams.
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Service type: Therapeutic electroconvulsive therapy
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Typical site of service: Inpatient psychiatric unit, hospital operating room, or an ambulatory surgical center where monitored anesthesia and resuscitation equipment are available
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65-year-old adult with severe, treatment-resistant major depressive disorder who has failed multiple trials of antidepressant medications and psychotherapy. The patient is evaluated by a psychiatrist and a multidisciplinary team, including an anesthesiologist and ECT nursing staff. Pre-procedure assessment includes psychiatric history, physical exam, medication reconciliation, informed consent, baseline cognitive testing, and medical clearance (ECG, basic labs). On the day of service the patient arrives to a hospital-based procedural suite or an outpatient surgical center. Under general anesthesia with a short-acting intravenous agent and a muscle relaxant, the provider applies an electric current to the patient’s scalp via electrodes to induce a controlled generalized seizure of therapeutic duration. Monitoring includes EEG, EKG, oxygen saturation, blood pressure, and end-tidal CO2. The typical treatment course is a series of procedures given two to three times weekly over several weeks, with periodic reassessment of mood symptoms and cognitive side effects. Post-procedure recovery occurs in a PACU or recovery bay with observation until return to baseline consciousness and stable vital signs. Documentation includes indication, informed consent, anesthesia record, stimulus dose and seizure duration, EEG tracing, pre- and post-treatment assessments, and discharge instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional work separate from facility or technical charges (rare for ECT when global billing applies). |