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What is CPT Code 90870? A Clear Guide to ECT Billing (2025)

Michael Reider

Jul 14, 2025

The CPT code 90870 serves as the billing code for Electroconvulsive Therapy (ECT) and has essential monitoring during the procedure. Healthcare providers received $13.6 million in Medicare allowed charges in 2000 through proper billing of this code.

ECT works as a brief electrical stimulation of the brain while patients remain under anesthesia. The ECT CPT code covers both the actual procedure and patient monitoring throughout the session. Medical professionals need to know the specific billing requirements since ECT becomes medically necessary for certain psychiatric conditions. This treatment proves valuable especially after medications and psychotherapy haven't worked.

This piece will show you the exact details of the 90870 CPT code description. You'll discover the proper documentation requirements to get reimbursed and learn ways to avoid billing mistakes that could cause claim denials. On top of that, you'll see the typical treatment path that needs six to twelve successful treatments. The information will help you understand not general CPT code rules, but specifics required for ECT billing across different insurance plans.

What is CPT Code 90870?

Definition and purpose of 90870

The American Medical Association's Current Procedural Terminology (CPT) code 90870 belongs to "Other Psychiatric Services or Procedures" [1]. This code represents electroconvulsive therapy (ECT) and covers all monitoring needed during the procedure [2]. Doctors use this code to bill for administering electric current to a patient's brain, which produces seizures that help ease symptoms of various mental disorders [3].

When to use this code in clinical practice

Doctors mainly use this code to treat major depression (unipolar, bipolar, or mixed types) that doesn't respond to medication [4]. ECT serves as the first choice of treatment in urgent cases where patients need quick symptom relief due to suicidal or homicidal thoughts [4].

Medical professionals can use ECT to treat these conditions:

Mania
Catatonia
Certain types of acute schizophrenia
Other psychotic conditions [4]

Some insurance providers might cover ECT for post-traumatic stress disorder, dementia, obsessive-compulsive disorder, body dysmorphic disorder, and complex regional pain syndrome [4]. Doctors should check with specific insurers about coverage before starting treatment for these conditions.

90870 CPT code description and scope

CPT code 90870 covers both the ECT procedure and required monitoring during convulsive and recovery phases [4]. This code isn't time-based - doctors should bill one unit per session [4].

Only physicians (MD/DO) can use this code [5]. The code's scope includes patient evaluation before ECT, so doctors shouldn't bill separately for evaluation and management or psychodiagnostic evaluation code (90792) [4].

The code covers most aspects of ECT treatment, but doctors can bill an additional evaluation and management service with modifier 25 if a patient needs significant separate assessment beyond standard ECT preparation [4].

Billing Guidelines for Electroconvulsive Therapy (ECT)

What's included in the 90870 billing

CPT code 90870 has several components beyond the procedure itself. The code includes all monitoring needed during convulsive and recovery phases. The psychiatrist's original evaluation of the patient comes bundled into this code. You cannot bill separately for assessment services [6].

Medicare doesn't allow separate payment for anesthesia services when the same psychiatrist performs both ECT and anesthesia [7]. The relative value units (RVUs) for CPT 90870 have increased to account for this bundling [8]. Providers who comply with quality data submission requirements will see their ECT payment per treatment rise by a lot to $661.52 for FY 2025 [9].

Common mistakes to avoid

Billing errors can lead to claim denials or reduced reimbursements. Improper documentation ranks as the most common mistake. Claims face immediate denials without proper medical necessity justification for ECT [6].

Incorrect session timing creates another common problem. Code 90870 isn't time-based, but sessions should last between 30-60 minutes [6]. Physicians sometimes try to bill separately for anesthesia services with code 00104. This code comes bundled with 90870 and can't be unbundled under any circumstances [10].

Some providers wrongly use code 90871 (multiple seizures per day). This approach rarely has clinical evidence support, so its use should be minimal [2].

Documentation requirements for reimbursement

Complete documentation helps process claims successfully. Your records must have:

History and physical examination
Patient's psychiatric diagnosis according to DSM criteria
Evaluation findings with relevant clinical signs and symptoms
Documentation of abnormal diagnostic/lab tests when applicable [8]

The clinical record should show ongoing assessment that includes the patient's treatment response and continued need for ECT [8]. Medicare beneficiaries not meeting covered indications need appropriate modifiers. Use GA if an Advance Beneficiary Notice is on file, or GZ if not [8].

Understanding Related Codes and Modifiers

CPT code 90870 works alongside several related codes and modifiers that affect ECT billing. Medical professionals need to understand these relationships to get proper reimbursement and follow payer rules.

Anesthesia code 00104 and its bundling rules

Anesthesia code 00104 covers anesthesia specifically for electroconvulsive therapy. This code bundles with CPT 90870 in most billing scenarios. Medicare and many other payers won't allow separate payment for anesthesia services when the same physician performs both ECT and gives anesthesia. The RVUs for CPT 90870 now include payment for anesthesia when a psychiatrist performs it [11].

CCI edits differ from CPT guidance and strictly bundle 00104 into 90870. They use a modifier indicator '0' that stops these codes from being reported together [1]. Facility billing combines 00104 and 90870 on the same service date in APC 0320. The OPPS considers packaged services as vital parts of another service [11].

Why 90871 is rarely used

Medical professionals rarely use CPT code 90871 (multiple seizures per day) in clinical practice. The NIH Consensus Development Conference Statement on ECT explained that "multiple-monitored ECT has not been demonstrated to be sufficiently effective to be recommended" [2]. Carrier medical directors suggest that 90871 should show very little use since doctors rarely perform this technique. Only anecdotal reports support its use [2].

The American Psychiatric Association Task Force on ECT suggests MMECT only "rarely." They limit it to no more than two seizures—nowhere near the 4-8 that MMECT supporters recommend [2].

Use of modifiers like GA, GZ, and 25

Billing for ECT services that might not meet coverage criteria needs specific modifiers:

GA modifier: Shows an Advance Beneficiary Notice (ABN) exists for patients who don't meet covered indications [11]
GZ modifier: Shows services don't meet coverage indications and no one got an ABN [11]
Modifier 25: Points out a vital, separate service provided on the same day as ECT [12]

These modifiers help explain billing expectations clearly. They make sure payers and patients understand their financial responsibilities.

Payer-Specific Rules and Compliance Tips

ECT billing can be complex because different insurance payers have unique requirements. Knowing these differences could determine whether you get paid quickly or face frustrating denials.

Medicare and CMS billing rules

Medicare has increased the reimbursement rate for electroconvulsive therapy (CPT code 90870) from $385.58 to $661.52 per treatment starting in fiscal year 2025. This 72% increase shows how CMS values ECT's role in psychiatric care [13].

Medicare beneficiaries need proper certification. A physician's original certification must show that the patient would need inpatient psychiatric hospitalization without ECT. The patient needs recertification by day 18 of treatment and every 30 days after that [14].

Medicare bundles anesthesia services (00104) with ECT (90870) strictly. You won't get separate reimbursement for anesthesia services because they're part of the ECT service [15].

Private payer variations

Private insurers often create their own policies, unlike Medicare's standard approach. To name just one example, Optum (including UnitedHealthcare) follows Medicare's bundling policy but might ask for different documentation [15].

Most private payers want prior authorization for ECT services. Claims often get denied because providers don't get this authorization before the service [5].

You should verify coverage details with each insurer before starting treatment. Reimbursement rates can vary a lot—approximately $230 for Medicaid to $300 for private insurance [6].

How to handle denials and appeals

Read all insurance company notifications carefully if you get a denial. This helps you understand why it happened [16]. Claims usually get denied due to missing documentation, medical necessity concerns, or incorrect coding.

Medical necessity denials need extra supporting documentation like:

Clinical records showing treatment history
Mental status examinations
Documentation of failed alternative treatments

Keep detailed records of all communications during appeals, including representative names [16]. Your persistence matters—you can potentially recover up to two-thirds of rejected claims [5].

Submit your appeals quickly. Payers usually give you 30 to 90 days to appeal [5]. Meeting these deadlines helps resolve disputed claims successfully.

Conclusion

Healthcare providers need a solid grasp of CPT code 90870 to bill for electroconvulsive therapy services. This standardized billing code includes the ECT procedure and all monitoring during treatment. Proper documentation is the life-blood of getting reimbursed, since ECT helps treat resistant depression and specific psychiatric conditions.

Medicare has increased its reimbursement rates to $661.52 per treatment for FY 2025, which shows how much this procedure matters clinically. Your practice revenue will grow when you stay up to date with these changes while providing vital care to patients who need it most.

Claim denials often stem from billing errors like improper bundling with anesthesia services or poor documentation. Each payer has their own specific requirements, so verifying coverage details before treatment becomes a vital step in your billing process.

You might face claim denials or need to direct complex payer requirements. A deep understanding of appropriate modifiers and appeal processes will help you succeed. ECT billing may look complicated initially, but knowing the details of code 90870 helps your psychiatric practice get fair compensation for this valuable treatment option.

Time spent learning these billing details leads to faster reimbursement, fewer denials, and better financial results. Your practice can thrive while providing life-changing care to patients who haven't responded to standard treatments.

FAQs

What does CPT code 90870 represent in medical billing?

CPT code 90870 represents Electroconvulsive Therapy (ECT), including all necessary monitoring during the procedure. It's used for billing purposes when a healthcare provider performs ECT to treat certain psychiatric conditions.

How much does Medicare reimburse for ECT treatments in 2025?

For fiscal year 2025, Medicare has increased the reimbursement rate for ECT treatments (CPT code 90870) to $661.52 per treatment for providers who comply with quality data submission requirements. This represents a significant increase from previous years.

Can anesthesia services be billed separately from ECT?

Generally, anesthesia services (code 00104) cannot be billed separately from ECT (code 90870). Medicare and many other payers bundle these services together, considering anesthesia as part of the overall ECT procedure.

What documentation is required for ECT reimbursement?

For ECT reimbursement, providers must document the patient's history, physical examination, psychiatric diagnosis (according to DSM criteria), relevant clinical signs and symptoms, and any abnormal diagnostic tests. The clinical record should also show ongoing assessment and the patient's response to treatment.

How should providers handle ECT claim denials?

When facing ECT claim denials, providers should carefully review the reason for denial, gather additional supporting documentation (such as clinical records and treatment history), and file appeals promptly. It's important to maintain detailed records of all communications with the insurance company during the appeal process.