Electroconvulsive therapy
CPT code 90870 is used when a healthcare provider performs electroconvulsive therapy (ECT), a medical procedure that uses controlled electrical currents to treat severe psychiatric conditions like major depression.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always verify place of service code (21 for inpatient hospital, 22 for outpatient hospital, 24 for ASC) as this determines facility vs non-facility rate
Impact: Incorrect POS code results in $65.66 payment difference between non-facility ($166.58) and facility ($100.92) rates
Bill anesthesia services separately using appropriate anesthesia codes (01920 for anesthesia for ECT) - never bundle with 90870
Impact: Failing to bill anesthesia separately leaves approximately $100-200 per session uncollected depending on anesthesia time and payer
Document the complete pre-treatment evaluation, stimulus parameters, seizure duration, and post-ictal monitoring in the medical record for each session
Impact: Inadequate documentation is the leading cause of denials; comprehensive notes reduce denial rate from 15-20% to under 5%
Submit claims with diagnosis codes that clearly establish medical necessity (F32.2, F32.3, F33.2, F33.3, F20.0-F20.9, F06.1)
Impact: Generic or non-specific depression codes increase denial risk by 30-40%; proper diagnosis coding supports first-pass payment
For Medicare patients, ensure the ECT treatment plan and consent documentation meets LCD requirements including failed prior treatments
Impact: Missing LCD documentation elements trigger automatic denials requiring costly appeals; proper front-end compliance ensures payment
Bill each treatment session separately on the date of service - do not combine multiple sessions into a single claim line
Impact: Bundling multiple sessions into one line item results in payment for only one session, losing $100.92-$166.58 per missed session
Common denials
Medical necessity not established - lack of documentation showing failed prior treatments or severity of condition
How to appeal: Submit comprehensive treatment history documenting specific antidepressant trials with doses, durations, and reasons for discontinuation; include psychiatric evaluation notes demonstrating severity, functional impairment, or urgent need for ECT
Missing or incomplete consent documentation for ECT treatment series
How to appeal: Provide signed informed consent forms specific to ECT including risks, benefits, alternatives, and patient/guardian acknowledgment; ensure consent is dated prior to treatment initiation and meets state-specific requirements
Frequency or number of treatments exceeds payer's coverage limitations without additional justification
How to appeal: Submit clinical notes documenting patient response, ongoing medical necessity for continuation, and psychiatrist's treatment plan; include objective measures such as PHQ-9, HAM-D scores showing treatment response or lack thereof requiring continuation
Bundling denial when billed with E/M service on same day without modifier 25
How to appeal: Resubmit claim with modifier 25 on E/M service if separately identifiable and documented; provide documentation showing the E/M service addressed issues beyond the ECT procedure (e.g., medication management, crisis intervention)
Frequently asked questions
What is the 2025 Medicare reimbursement rate for CPT code 90870?
The 2025 Medicare national average reimbursement for CPT 90870 is $166.58 for non-facility settings and $100.92 for facility settings. Actual rates may vary by geographic locality based on GPCI adjustments.
How many times can you bill CPT 90870 for a patient?
You can bill 90870 for each individual ECT treatment session performed. While there is no absolute limit, typical acute treatment courses involve 6-12 sessions over 2-4 weeks. Sessions beyond typical protocols require strong medical necessity documentation, and some payers impose coverage limits requiring prior authorization for continuation.
Can you bill an E/M code on the same day as CPT 90870?
Yes, but only if the E/M service is separately identifiable and documented beyond the standard pre-procedure evaluation included in 90870. You must append modifier 25 to the E/M code and document a distinct problem or service such as medication management, crisis intervention, or treatment plan modification unrelated to the ECT procedure itself.
What diagnosis codes are required to bill CPT 90870?
Common supporting diagnoses include severe major depressive disorder (F32.2, F32.3, F33.2, F33.3), bipolar disorder with severe depression (F31.4, F31.5), catatonia (F06.1), or treatment-resistant schizophrenia (F20.x). Documentation must demonstrate severity, treatment resistance, or urgent clinical need to support medical necessity.
Is anesthesia included in CPT code 90870 reimbursement?
No, anesthesia is not included in CPT 90870 and must be billed separately by the anesthesia provider using code 01920 (anesthesia for ECT). The psychiatrist bills 90870 for performing the ECT procedure, while the anesthesiologist or CRNA bills separately for anesthesia administration and monitoring.
What is the RVU value for CPT code 90870 in 2025?
CPT 90870 has a total RVU of 5.15 in 2025, consisting of 2.5 work RVUs, 2.55 practice expense RVUs (non-facility) or 0.52 PE RVUs (facility), and 0.1 malpractice RVUs. These values are multiplied by the 2025 conversion factor of 32.3465 to determine payment.
Does Medicare cover electroconvulsive therapy (CPT 90870)?
Yes, Medicare covers ECT when medically necessary for conditions such as severe depression, bipolar disorder, schizophrenia, or catatonia that have not responded to other treatments. Coverage requires documentation of failed prior treatments, severity of condition, and informed consent. Local Coverage Determinations (LCDs) may specify additional requirements in certain Medicare regions.