CPT 90870Mental Health

Electroconvulsive therapy

CPT code 90870 covers electroconvulsive therapy (ECT), a medical treatment where controlled electrical currents are passed through the brain to treat severe mental health conditions. This procedure is performed under anesthesia and is typically used when other treatments have failed.

Showing rates for

National Average

Base Medicare rate

$166.58

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.5

PE RVU (NF)

2.55

MP RVU

0.1

Total RVU

5.15

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill the psychiatrist's ECT service (90870) separately from anesthesia services; anesthesiologist bills separately using anesthesia codes (01120 or 01140)
Impact: Prevents bundling denials and ensures both providers receive appropriate reimbursement; failure to separate can result in 100% denial of one service
Always verify the place of service code: 22 for outpatient hospital ($166.58) vs 24 for ASC ($100.92), as this creates a $65.66 difference in Medicare reimbursement
Impact: Using incorrect POS code can trigger automatic downcoding or denial; accurate POS ensures proper facility vs non-facility rate application
Document medical necessity including prior treatment failures, current symptom severity scales (HAM-D, PHQ-9), and informed consent in the medical record before each series
Impact: Reduces denial rate by 60-70% for medical necessity reviews; particularly important for Medicare Advantage and commercial payers who frequently audit ECT claims
For patients receiving maintenance ECT, ensure each treatment has a separate dated encounter note with current mental status exam and treatment response assessment
Impact: Maintenance ECT (beyond acute series) has higher audit scrutiny; proper documentation supports continued medical necessity and prevents recoupment of $500-$2,000 per denied session
Submit claims for bilateral ECT using 90870 without special modifiers; do not attempt to upcode for bilateral vs unilateral electrode placement as CPT 90870 covers both
Impact: Prevents fraud flags and compliance issues; electrode placement is already factored into the RVU value (5.15 total RVUs)
When billing for ECT series, track frequency and duration patterns; Medicare and most payers cover acute series (6-12 treatments over 2-4 weeks) but require additional documentation for treatments extending beyond 30 days

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 90870 in 2025?

The 2025 Medicare national average reimbursement for CPT 90870 is $166.58 in the non-facility setting and $100.92 in the facility setting. The total RVU is 5.15 (2.5 work RVU, 2.55 non-facility PE RVU, 0.52 facility PE RVU, and 0.1 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can you bill an E/M service on the same day as electroconvulsive therapy?

Generally no, because the pre-procedure evaluation is considered included in CPT 90870. However, if a significant, separately identifiable E/M service is performed (such as crisis intervention, initial consultation for new patient, or unrelated medical issue), you may bill the E/M with modifier 25. The documentation must clearly show the E/M service was distinct from the routine pre-ECT assessment.

How many ECT treatments does Medicare typically cover?

Medicare does not have a specific national limitation on the number of ECT treatments, but coverage is based on medical necessity. Acute treatment series typically involve 6-12 treatments over 2-4 weeks. Maintenance ECT requires ongoing documentation of medical necessity. Medicare Administrative Contractors (MACs) may have local coverage determinations with specific requirements, so verify your regional MAC policy.

Who can perform and bill for electroconvulsive therapy?

CPT 90870 must be performed and billed by a physician (MD or DO), typically a psychiatrist with specialized ECT training and hospital privileges. The physician performing the ECT bills 90870, while the anesthesiologist separately bills for anesthesia services (typically 01120 or 01140). Facilities bill separately for the facility fee using revenue codes.

Is prior authorization required for billing CPT code 90870?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for ECT, but Medicare Advantage plans often do. Most commercial insurance plans require prior authorization, especially for maintenance ECT beyond the acute series. Medicaid requirements vary by state. Always verify with the specific payer before initiating treatment to avoid denials.

What documentation is needed to support medical necessity for ECT billing?

Required documentation includes: psychiatric diagnosis (typically severe depression, bipolar disorder, or catatonia), history of failed prior treatments with specific medications and doses, current symptom severity using standardized scales, psychiatric evaluation supporting ECT indication, informed consent, medical clearance including cardiac assessment, and treatment response tracking. Each session should have a dated encounter note with mental status exam.

Can bilateral and unilateral ECT be billed differently?

No, both bilateral and unilateral electrode placement are reported using the same CPT code 90870. The code descriptor 'electroconvulsive therapy' encompasses both techniques, and the RVU value already accounts for the work involved regardless of electrode placement. Attempting to bill these differently or add modifiers for electrode placement type is inappropriate and may trigger compliance issues.