ECT Billing 90870 — 2026 Electroconvulsive Therapy Guide

Electroconvulsive Therapy (ECT) billing is a niche high-value BH service. CPT 90870 (electroconvulsive therapy, includes necessary monitoring) is straightforward per-treatment billing but requires strict pre-treatment documentation.

90870 Rules 2026

• Per-treatment billing (not time-based)
• Physician (typically psychiatrist) delivers
• Anesthesia provider bills separately
• Facility fee billed separately (POS 22 outpatient hospital)
• Series authorization required (typically 6-12 sessions)

Common ECT Denials

1. Pre-authorization for series expired
2. Anesthesia billing conflict
3. Second-opinion documentation missing
4. Maintenance ECT authorization gaps

Recovery Framework

Pre-authorize entire series upfront. Track authorization expiration. Coordinate anesthesia billing. Document response for maintenance authorization.

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– KD, Revenant Care