Aetna modified CPB 0445 governing electroconvulsive therapy (ECT) coverage, effective February 27, 2026. Here's what billing teams need to know.
Aetna, a CVS Health company, updated CPB 0445 to clarify which ECT-related services it covers and which it classifies as experimental. The policy directly affects CPT 90870 (ECT with monitoring) and CPT 00104 (anesthesia for ECT), while also drawing hard lines around several adjunctive treatments and off-label indications. If your facility or psychiatric practice bills ECT for Aetna members, this coverage policy update changes how you document medical necessity and what you can — and cannot — include on the claim.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Electroconvulsive Therapy — CPB 0445 |
| Policy Code | CPB 0445 |
| Change Type | Modified |
| Effective Date | February 27, 2026 |
| Impact Level | High |
| Specialties Affected | Psychiatry, Anesthesiology, Inpatient Behavioral Health, Hospital Outpatient |
| Key Action | Audit your ECT charge capture to confirm CPT 90870 claims are tied to covered diagnoses and that adjunctive services like ketamine, liothyronine (J0654), and TMS (CPT 90867–90869) are not being billed alongside ECT |
Aetna Electroconvulsive Therapy Coverage Criteria and Medical Necessity Requirements 2026
The Aetna ECT coverage policy under CPB 0445 covers ECT when a member carries one of five diagnoses. These are the only covered indications:
| # | Covered Indication |
|---|---|
| 1 | Catatonia |
| 2 | Certain acute schizophrenic exacerbations |
| 3 | Major depressive disorder (unipolar) |
| 4 | Bipolar disorder |
| 5 | Mania |
The core procedure code here is CPT 90870, which covers electroconvulsive therapy including necessary monitoring. CPT 00104 covers anesthesia for ECT and is also covered when selection criteria are met. Both codes require a covered diagnosis — if the ICD-10 on the claim doesn't match the approved list, you're looking at a claim denial.
One clinical nuance with direct billing impact: Aetna explicitly states that more than 20 ECT sessions in a single treatment series is rarely medically necessary for remission. However, continuation and prophylactic ECT — less frequent sessions used to prevent relapse — can continue beyond that threshold, sometimes indefinitely. Document the clinical rationale clearly when billing beyond 20 sessions. That documentation is what separates an approved claim from a medical necessity dispute.
CPB 0445 does not specify prior authorization requirements. Prior auth requirements vary by plan. Verify with the member's specific Aetna plan before scheduling — commercial plan riders frequently add prior authorization requirements that the base CPB doesn't spell out.
Schizophrenia coverage deserves extra attention. ICD-10 codes F20.0 through F20.9 are covered — but only for acute exacerbations. Treatment-resistant schizophrenia is explicitly excluded as experimental. If the documentation describes treatment-resistant schizophrenia rather than an acute exacerbation, the claim won't survive review. Make sure your documentation language matches the covered clinical scenario.
Aetna ECT Exclusions and Non-Covered Indications
This is where CPB 0445 draws the sharpest lines — and where your billing team needs to pay close attention.
Aetna classifies the following ECT variants as experimental, investigational, or unproven:
| # | Excluded Procedure |
|---|---|
| 1 | Multiple monitored ECT — not covered |
| 2 | Ultrabrief bilateral ECT — CPT 90870 specifically excludes this variant (noted in the code description) |
| 3 | Adjunctive ketamine in ECT — ketamine used alongside ECT is classified as experimental. CPB 0445 does not assign a specific HCPCS code to ketamine in this context |
| 4 | Liothyronine (HCPCS J0654) for cognitive function during ECT — Aetna considers liothyronine experimental when used to improve cognitive function in persons undergoing ECT. J0654 is not covered for this indication |
| 5 | Combined ECT with transcranial magnetic stimulation (TMS) — CPT 90867, 90868, and 90869 are not covered when billed in combination with ECT for psychiatric indications |
The off-label indication exclusion list is long — 21 conditions in total. Billing ECT for any of these is a guaranteed denial:
Addictive disorders, autism spectrum disorders, autoimmune encephalitis, body dysmorphic disorder, borderline personality disorder, complex regional pain syndrome, delirium, dementia-associated agitation and aggression, drug-resistant epilepsy, eating disorders, Lennox-Gastaut syndrome, Parkinson's motor symptoms, neuropsychiatric complications of COVID-19, OCD, PTSD, refractory status epilepticus, self-injurious behaviors, somatic symptom disorder, tardive dyskinesia, Tourette syndrome, and treatment-resistant schizophrenia.
Functional MRI codes CPT 70554 and 70555 — sometimes ordered to predict ECT outcomes in major depression — are also not covered under this policy. Don't bill these as part of an ECT workup and expect reimbursement from Aetna.
EEG use for predicting ECT response in major depression is similarly excluded. Neither the EEG itself nor its interpretation qualifies for coverage under this clinical context per CPB 0445.
The cognitive enhancement angle is also worth flagging. Some clinicians use cholinesterase inhibitors, memantine, melatonin, liothyronine, or piracetam to manage cognitive side effects during ECT. Aetna considers all of these experimental. HCPCS J0654 (liothyronine, 1 mcg) is explicitly listed in the not-covered codes for this indication.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Major depressive disorder (unipolar) | Covered | CPT 90870, 00104; ICD-10 F32.0–F33.9 | >20 sessions requires documented clinical rationale |
| Bipolar disorder | Covered | CPT 90870, 00104; ICD-10 F31.0–F31.9 | Verify plan-level prior auth requirements |
| Mania | Covered | CPT 90870, 00104; ICD-10 F30.10–F30.9 | |
| Catatonia | Covered | CPT 90870, 00104; ICD-10 F06.1 | |
| Acute schizophrenic exacerbations | Covered | CPT 90870, 00104; ICD-10 F20.0–F20.9 | Acute exacerbation only — not treatment-resistant schizophrenia |
| Ultrabrief bilateral ECT | Not Covered | CPT 90870 (excluded variant) | Explicitly excluded in code description |
| Multiple monitored ECT | Experimental | — | Not covered by Aetna |
| Adjunctive ketamine with ECT | Experimental | No specific HCPCS code identified in CPB 0445 | Ketamine as adjunct is unproven |
| Liothyronine for cognitive function during ECT | Experimental | HCPCS J0654 | Listed as experimental cognitive function agent in ECT context |
| ECT + TMS combination | Experimental | CPT 90867, 90868, 90869 | Combined neuro-stimulation not covered |
| Eating disorders | Experimental | ICD-10 F50.0–F50.9 | On explicit exclusion list |
| PTSD | Experimental | ICD-10 F40.00–F48.9 range | Not a covered ECT indication |
| OCD | Experimental | ICD-10 F40.00–F48.9 range | Not a covered ECT indication |
| Treatment-resistant schizophrenia | Experimental | — | Distinguished from covered acute exacerbations |
| Borderline personality disorder | Experimental | ICD-10 F60.3 | Listed explicitly in exclusions |
| Dementia-associated agitation | Experimental | ICD-10 F01.50–F03.C4 | Not covered despite covered dementia ICD-10s being listed |
| Autism spectrum disorders | Experimental | ICD-10 F84.0–F84.9 | Not covered |
| Tourette syndrome / tic disorders | Experimental | ICD-10 F95.0–F95.1 | Not covered |
| Parkinson's motor symptoms | Experimental | — | Not covered |
| Functional MRI for ECT outcome prediction | Experimental | CPT 70554, 70555 | Not covered for this indication |
| EEG for ECT response prediction | Experimental | — | Not covered for major depression context |
| Prophylactic cognitive enhancers during ECT | Experimental | HCPCS J0654 (liothyronine) | Cholinesterase inhibitors, memantine, melatonin also excluded |
Aetna ECT Billing Guidelines and Action Items 2026
These steps apply immediately given the effective date of February 27, 2026.
| # | Action Item |
|---|---|
| 1 | Audit your CPT 90870 claims for diagnosis alignment. Pull Aetna ECT claims from the past 90 days. Confirm every claim ties to one of the five covered ICD-10 groups — catatonia, acute schizophrenia exacerbation, major depressive disorder, bipolar disorder, or mania. Any claim with an off-label diagnosis is a future denial risk. |
| 2 | Flag claims exceeding 20 sessions in a treatment series. Aetna's medical necessity standard treats anything beyond 20 sessions as an outlier requiring justification. Make sure your documentation explicitly supports continuation — either as prophylaxis or for clinical reasons. Missing this documentation is what triggers retrospective denial requests. |
| 3 | Remove adjunctive and experimental codes from ECT claim bundles. If your charge capture includes CPT 90867, 90868, or 90869 alongside CPT 90870, pull those off Aetna claims now. Aetna considers TMS combined with ECT experimental. Billing them together draws attention and flags the whole claim. Handle J0654 (liothyronine) separately — see item 4 below. |
| 4 | Flag J0654 in the cognitive enhancement context. If your team bills HCPCS J0654 (liothyronine) for cognitive support during ECT, stop doing that on Aetna claims. Aetna classifies liothyronine as experimental when used to improve cognitive function in ECT patients. This is a separate issue from adjunctive ketamine — ketamine has no specific HCPCS code identified in CPB 0445 and should not be coded using J0654. |
| 5 | Verify prior auth status before the first ECT session. CPB 0445 does not specify prior authorization requirements. But Aetna commercial plans often add prior auth requirements at the plan level. Check the member's specific coverage before scheduling — don't rely on the base CPB alone. |
| 6 | Update your ICD-10 documentation protocols for schizophrenia. Your providers need to document acute exacerbation clearly and specifically — not just list schizophrenia. Treatment-resistant schizophrenia is explicitly non-covered. The clinical note language drives the diagnosis code, and the diagnosis code drives the coverage determination. |
| 7 | Don't bill CPT 70554 or 70555 as part of an ECT workup. Functional MRI for ECT outcome prediction is not covered. If your psychiatric team orders these routinely pre-ECT for Aetna members, that's a pattern your compliance officer needs to review. |
| 8 | Loop in your compliance officer if you're billing ECT for dementia-associated agitation. This one is a gray zone. Dementia ICD-10 codes (F01.50–F03.C4) appear in the policy's code table, but ECT for dementia-associated agitation is explicitly on the experimental list. Don't assume a listed ICD-10 code means covered status — the indication matters. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Electroconvulsive Therapy Under CPB 0445
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 00104 | CPT | Anesthesia for electroconvulsive therapy |
| 90870 | CPT | Electroconvulsive therapy (includes necessary monitoring) — not covered for ultrabrief bilateral ECT |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 70554 | CPT | Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive stimuli | Not covered — experimental for ECT outcome prediction in major depression |
| 70555 | CPT | Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing | Not covered — experimental for ECT outcome prediction |
| 90867 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping | Not covered — TMS combined with ECT is experimental |
| 90868 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management | Not covered — TMS combined with ECT is experimental |
| 90869 | CPT | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination | Not covered — TMS combined with ECT is experimental |
| E0732 | HCPCS | Cranial electrotherapy stimulation (CES) system, any type | Not covered for indications listed in CPB 0445 |
| J0654 | HCPCS | Injection, liothyronine, 1 mcg | Not covered — experimental as cognitive function agent in ECT context |
Key ICD-10-CM Diagnosis Codes
| Code Range | Description | Coverage Status |
|---|---|---|
| F06.1 | Catatonic disorder due to known physiological condition | Covered |
| F20.0–F20.9 | Schizophrenia | Covered for acute exacerbations only |
| F25.0–F25.9 | Schizoaffective disorder | Listed in policy |
| F30.10–F30.9 | Manic episode | Covered |
| F31.0–F31.9 | Bipolar disorder | Covered |
| F32.0–F33.9 | Major depressive disorder | Covered |
| F34.1 | Dysthymic disorder | Listed in policy |
| F01.50–F03.C4 | Dementia | Listed in policy — ECT for dementia-associated agitation is experimental; verify indication |
| F10.10–F19.99 | Mental and behavioral disorders due to psychoactive substance use | Listed — addictive disorders are experimental ECT indication |
| F40.00–F48.9 | Anxiety, dissociative, stress-related, somatoform, and other non-psychotic disorders | Listed — PTSD, OCD, somatic disorders are experimental ECT indications |
| F50.0–F50.9 | Eating disorders | Listed — eating disorders are experimental ECT indication |
| F60.0–F60.9 | Specific personality disorders | Listed — borderline personality disorder is experimental ECT indication |
| F84.0–F84.9 | Pervasive developmental disorders (autism spectrum) | Listed — autism spectrum is experimental ECT indication |
| F95.0–F95.1 | Tic disorders | Listed — Tourette syndrome/tic disorders are experimental ECT indication |
| F06.70–F06.71 | Mild neurocognitive disorder due to known physiological condition | Listed in policy |
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