CPT 90870: Electroconvulsive Therapy

• CPT Codes
• 90870

CPT 90870: Electroconvulsive Therapy

CPT code 90870 for electroconvulsive therapy billing. Documentation, reimbursement, and compliance for behavioral health providers.

Quick Reference

Code

90870

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

8 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90870: Electroconvulsive Therapy (ECT)

CPT code 90870 covers electroconvulsive therapy (ECT), a specialized medical procedure used to treat severe mental health conditions that have not responded to other treatments. For behavioral health providers operating inpatient psychiatric units or hospital-based outpatient ECT programs, understanding proper billing for this procedure is critical for capturing reimbursement and maintaining compliance. ECT remains one of the most effective treatments available for treatment-resistant depression and other severe psychiatric conditions.

ECT involves administering controlled electrical currents to the brain under general anesthesia to induce a brief therapeutic seizure. Despite persistent stigma, modern ECT is performed under tightly controlled medical conditions with refined technique, updated anesthesia protocols, and well-established safety parameters. It is an essential treatment option in behavioral health, particularly for patients with severe, treatment-resistant mood disorders or psychiatric emergencies where rapid treatment response is needed.

Definition and Purpose

CPT code 90870 is defined as electroconvulsive therapy (ECT), including necessary monitoring during the procedure. The code covers the psychiatrist’s work in performing the ECT procedure, including positioning the electrodes, administering the electrical stimulus, monitoring the seizure, and managing the patient during the procedure.

The purpose of 90870 is to provide a billing code for the psychiatrist’s professional service in delivering ECT. Anesthesia services, recovery room monitoring, and facility fees are billed separately under their respective codes.

Key characteristics of 90870 include:

• Service type: ECT procedure delivery and monitoring
• Setting: Inpatient psychiatric unit, hospital outpatient department, or ambulatory surgical center
• Anesthesia: General anesthesia is administered separately (billed by anesthesia provider)
• Provider: Performed by a psychiatrist or qualified physician
• Billing unit: Per treatment session
• Treatment course: Typically 6 to 12 acute treatments, with possible maintenance treatments

When to Use 90870 in Behavioral Health

90870 is used each time an ECT treatment is administered to a patient.

Treatment-resistant major depression: The most common indication for ECT in behavioral health is major depressive disorder that has not responded to adequate trials of antidepressant medications and psychotherapy. ECT is particularly indicated when the depression is severe, when it includes psychotic features, or when the patient is at acute risk of suicide and rapid treatment response is necessary.

Severe bipolar disorder: ECT is effective for both manic and depressive episodes of bipolar disorder, particularly when these episodes are severe, treatment-resistant, or when rapid stabilization is needed. It may be used for patients who cannot tolerate or have not responded to mood stabilizers and other pharmacological treatments.

Catatonia: ECT is considered a first-line treatment for catatonia, a syndrome that can occur in the context of mood disorders, psychotic disorders, or medical conditions. Catatonia can be life-threatening when it leads to malignant catatonia, and ECT often produces dramatic improvement.

Schizoaffective disorder: Patients with schizoaffective disorder who have prominent mood symptoms that are treatment-resistant may benefit from ECT. The procedure is particularly useful when the mood component of the illness is not responding to medications.

Maintenance ECT: After a successful acute course of ECT, some patients receive maintenance treatments at gradually increasing intervals to prevent relapse. Maintenance ECT is billed under 90870 for each session and may continue for months or years for patients who are prone to relapse.

Providers should use 90870 only when a formal ECT procedure is performed. Pre-procedure evaluations, post-procedure assessments, and anesthesia services are billed under their respective codes.

Documentation Requirements

ECT documentation must meet rigorous standards due to the procedural nature of the service and the general anesthesia requirement.

Pre-procedure assessment: Document a comprehensive pre-procedure assessment for each treatment, including the patient’s current mental status, vital signs, any changes since the last treatment, and confirmation that informed consent remains valid. Assess the patient’s medical readiness for anesthesia.

Treatment parameters: Record the specific ECT treatment parameters for each session, including electrode placement (bilateral, right unilateral, or bifrontal), stimulus dosage, charge delivered, seizure duration (both motor and EEG), and seizure quality. These parameters are essential for clinical management and billing support.

Procedure note: Write a procedure note for each ECT treatment documenting the date and time, the provider performing the procedure, the anesthesia provider, medications administered (muscle relaxant, anesthetic agent), the stimulus parameters used, seizure characteristics, and any complications or adverse events.

Post-procedure monitoring: Document the patient’s recovery from anesthesia, including post-procedure mental status, vital signs, any side effects such as confusion, memory impairment, or headache, and the patient’s overall condition at discharge from the recovery area.

Treatment course documentation: Maintain running documentation of the overall treatment course, including the number of treatments completed, cumulative response to ECT, side effects over time, and ongoing assessment of treatment goals. This longitudinal record supports medical necessity for continued treatments.

Informed consent: Document that informed consent was obtained before initiating the ECT treatment course. Consent should cover the nature of the procedure, expected benefits, risks, alternatives, and the right to withdraw consent at any time. Re-consent may be required if the treatment plan changes significantly.

Billing and Reimbursement

As of March 2026, ECT reimbursement reflects the specialized and procedural nature of the service.

Medicare: Medicare covers ECT for medically necessary indications. Professional component reimbursement for the psychiatrist performing the procedure (90870) is typically in the range of $140 to $200 per treatment, depending on geographic locality. Facility fees and anesthesia charges are billed and reimbursed separately. Rates are determined by the Medicare Physician Fee Schedule.

Medicaid: Most state Medicaid programs cover ECT for approved indications, though reimbursement rates vary by state. Some states have specific policies regarding the number of treatments covered per episode or per year. Verify state-specific guidelines.

Commercial payers: Most commercial payers cover ECT for treatment-resistant depression and other approved indications. Prior authorization is typically required. Reimbursement rates are contract-dependent. Some payers have utilization management policies that limit the number of treatments per authorization period.

Billing tips:

• Bill 90870 for each ECT treatment session
• Bill the professional component only if the facility bills the technical component separately
• Ensure that anesthesia services are billed by the anesthesia provider under the appropriate anesthesia codes
• Obtain and maintain prior authorization for the treatment course
• Track the number of treatments against the authorized limit and request reauthorization before reaching the cap
• Submit claims promptly after each treatment to maintain cash flow

Common Modifiers

Modifiers that may apply when billing 90870 include:

Verify payer-specific modifier requirements. ECT modifier policies can vary significantly between Medicare, Medicaid, and commercial payers.

• Modifier 26: Professional component — use when billing only the professional component of the ECT service (the psychiatrist’s work), with the facility billing the technical component separately
• Modifier TC: Technical component — use when billing only the technical/facility component
• Modifier 76: Repeat procedure by same physician — may be required by some payers for subsequent ECT treatments in the same course
• Modifier 59: Distinct procedural service — used when ECT needs to be distinguished from other services on the same date
• Modifier 25: Significant, separately identifiable E&M service — append to an E&M code if a separately identifiable E&M service is provided on the same date as ECT

Compliance Considerations

ECT billing involves substantial compliance requirements due to the procedural nature of the service, the use of general anesthesia, and the high per-treatment reimbursement.

Medical necessity documentation: Each ECT treatment must be supported by documented medical necessity. The patient’s record should clearly establish the diagnosis, the history of treatment resistance, the rationale for ECT, and the ongoing clinical justification for each treatment in the course. Payers will review this documentation during audits.

Informed consent requirements: Ensure that informed consent meets all state and federal requirements. Some states have specific ECT consent laws that require additional disclosures, waiting periods, or capacity assessments. Failure to comply with consent requirements can create both legal and billing compliance issues.

Prior authorization management: Maintain active prior authorization throughout the treatment course. Billing treatments beyond the authorized number without obtaining reauthorization can result in claim denials, recoupments, and compliance violations. Implement a tracking system to monitor authorization limits.

Facility and equipment standards: ECT must be performed in an appropriate clinical setting with properly maintained equipment and qualified staff. Ensure that the facility meets all accreditation and regulatory requirements for performing ECT, including emergency equipment and recovery capabilities.

Anesthesia coordination: Ensure proper coordination between the psychiatrist performing the ECT and the anesthesia provider. Each provider should bill for their respective services, and claims should be consistent in terms of dates, times, and procedure details. Discrepancies between psychiatrist and anesthesiology claims can trigger audits.

Outcome monitoring: Document treatment outcomes systematically using validated assessment tools. Tracking outcomes supports medical necessity for continued treatment and strengthens the provider’s position in the event of a payer audit or clinical review.

Related Billing Codes

• 90853
• 90863
• 90869
• 90875
• 90876
• 90887

Common questions

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