CurrentOptumPolicy 2017RP510A

Electroconvulsive Therapy (ECT) reimbursement

This policy governs reimbursement rules for Electroconvulsive Therapy (ECT) services billed to Optum-administered behavioral health benefit plans, affecting facility and professional providers submitting CMS 1500 and UB-04 claims.

Policy Summary

PayerOptum

PolicyElectroconvulsive Therapy (ECT) reimbursement

Policy CodePolicy 2017RP510A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain authorization or provide notification for inpatient ECT per the member's benefit plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3Codes referenced

bundledAnesthesia reimbursement

facility & professionalClaim types

requiredPrior auth note

ECT Reimbursement Criteria

ECT reimbursement criteria

Covered when ALL of the following are met:

Facility claims for ECT are submitted with revenue code 0901 and CPT code 90870; anesthesia (CPT 00104) is included on the claim.

Professional (non-facility) claims for ECT are submitted with CPT code 90870 and CPT code 00104 for anesthesia.

Authorization or notification for an acute inpatient stay is obtained when inpatient ECT is provided, as required by the member's benefit plan.

Anesthesia services (CPT 00104), including anesthesiologist services, billed with ECT (revenue code 0901 and CPT 90870) are considered part of the bundled ECT payment and will not be reimbursed separately unless specified by facility contract.

Procedure, Anesthesia, and Revenue Codes

Policy Summary

PayerOptum

PolicyElectroconvulsive Therapy (ECT) reimbursement

Policy CodePolicy 2017RP510A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain authorization or provide notification for inpatient ECT per the member's benefit plan.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Referenced procedure and revenue codesCPT | HCPCS | RevenueCovered

90870	Electroconvulsive therapy (includes necessary monitoring)
00104	Anesthesia for electroconvulsive therapy
0901	Electroconvulsive Treatment (facility)

Bundling rule — anesthesia and revenue code 0901

Bundling ruleAnesthesia services (CPT 00104) billed with ECT (CPT 90870) and facility revenue code 0901 are considered part of the bundled ECT rate and are not reimbursed separately; claims for anesthesia will be considered part of the ECT service and not paid separately.

Claim submission — facilityFacility-based ECT claims must be submitted with revenue code 0901 and CPT codes 90870 and 00104 to be considered for reimbursement.

Claim submission — professionalProfessional ECT claims must be submitted with CPT code 90870 and 00104 for anesthesia.

Reference guidanceThis bundling approach is consistent with CMS guidelines and the National Correct Coding Initiative; listing of codes is for reference only and does not guarantee payment.

Provider Authorization & Billing Actions

Prior Authorization

Inpatient authorization/notification required for ECT

Authorization or notification must be obtained for an acute inpatient stay when inpatient ECT is provided, per the member's benefit plan. Contact the member's behavioral health benefit administrator to confirm prior authorization or notification requirements before admission.

Obtain prior authorization or provide required notification for inpatient ECT per the member's benefit plan.
Verify authorization requirements with the member's behavioral health benefit administrator before admission to avoid claim denials or payment delays.

OpenPayer

Electroconvulsive Therapy (ECT) reimbursement

ECT Reimbursement Criteria

Procedure, Anesthesia, and Revenue Codes

Provider Authorization & Billing Actions

Key Terms