TL;DR: Aetna, a CVS Health company, modified CPB 0445 governing electroconvulsive therapy coverage, effective February 27, 2026. If your team bills CPT 90870 or 00104 for Aetna members, here's what the updated coverage policy means for your claims.
Aetna's ECT coverage policy under CPB 0445 draws a sharp line between covered indications and a long list of experimental uses. The updated policy keeps CPT 90870 (ECT, includes necessary monitoring) and CPT 00104 (anesthesia for ECT) covered for five core diagnoses — but explicitly excludes 21 clinical indications and several adjunctive approaches. Billing teams that miss the exclusion list will face claim denials.
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 | Medium — affects psychiatry, anesthesia, and hospital-based billing teams |
| Specialties Affected | Psychiatry, Anesthesiology, Hospital Outpatient, Inpatient Behavioral Health |
| Key Action | Audit active ECT claims and charge capture for excluded indications before billing on or after February 27, 2026 |
Aetna Electroconvulsive Therapy Coverage Criteria and Medical Necessity Requirements 2026
Aetna's electroconvulsive therapy coverage policy under CPB 0445 covers ECT — billed as CPT 90870 — for five diagnoses. Medical necessity is established when the member carries one of these:
| # | Covered Indication |
|---|---|
| 1 | Catatonia |
| 2 | Certain acute schizophrenic exacerbations |
| 3 | Major depressive disorder (unipolar) |
| 4 | Bipolar disorder |
| 5 | Mania |
That's the full covered list. If the diagnosis doesn't match one of those five, Aetna considers ECT experimental or not medically necessary for that indication.
The schizophrenia carve-out matters. ICD-10 codes F20.0 through F20.9 cover schizophrenia only for acute exacerbations. Treatment-resistant schizophrenia as a standalone indication is explicitly experimental under this policy. Document the acute exacerbation clearly in the clinical record — "schizophrenia" alone won't be enough to defend that claim.
On session limits, Aetna notes that more than 20 sessions in a single treatment series is rarely medically necessary for remission. Ensure clinical documentation supports the continued need if billing beyond this threshold. Prophylactic ECT — less frequent maintenance sessions — can continue beyond 20, sometimes indefinitely, but the clinical rationale needs to be in the chart.
CPT 00104 (anesthesia for ECT) follows the same coverage criteria as CPT 90870. It's covered when ECT itself is covered, and not covered when it isn't. Don't bill 00104 on a claim where the underlying ECT would be denied — that anesthesia code will fall with it.
The Aetna ECT coverage policy does not list specific prior authorization requirements in the CPB text itself. That doesn't mean prior auth is off the table. Prior authorization requirements vary by plan and member benefit design. Check the member's specific plan before scheduling a series, especially for maintenance ECT beyond 20 sessions. If you're unsure, call Aetna provider services before the first session — not after.
Aetna ECT Exclusions and Non-Covered Indications
This is where the policy gets detailed — and where denials will come from if your billing team isn't careful.
Aetna considers the following forms of ECT experimental and investigational:
| # | Excluded Procedure |
|---|---|
| 1 | Multiple monitored ECT — not covered |
| 2 | Ultrabrief bilateral ECT — not covered (CPT 90870 is explicitly noted as not covered for this variant) |
| 3 | Adjunctive ketamine during ECT — not covered |
Beyond technique variants, Aetna lists 21 clinical indications where ECT is considered experimental. This is a long list, and several items will surprise teams that follow emerging clinical literature. Aetna explicitly calls out ECT for autism spectrum disorders, borderline personality disorder, PTSD, OCD, eating disorders, Parkinson's motor symptoms, dementia-associated agitation, and neuropsychiatric complications of COVID-19 — all experimental.
Treatment-resistant schizophrenia is also on the excluded list. This is worth repeating because it's counterintuitive. Acute schizophrenic exacerbations are covered. Treatment-resistant schizophrenia is not. The ICD-10 code may look the same. The clinical scenario is different. Train your authorization and billing teams to understand that distinction.
Aetna also calls out several adjunctive diagnostic and monitoring approaches as experimental:
| # | Excluded Procedure |
|---|---|
| 1 | Functional MRI of fronto-temporal connectivity to predict ECT outcomes — CPT 70554 and 70555 are not covered for this indication |
| 2 | EEG for predicting ECT response in major depression — not covered |
| 3 | Plasma brain-derived neurotrophic factor (BDNF) measurement as a treatment response indicator — not covered |
For adjunctive medications used to manage cognitive side effects of ECT, Aetna draws another hard line. Ketamine, liothyronine (HCPCS J0654), melatonin, opioid receptor agonists, piracetam, and prophylactic cognitive enhancers like cholinesterase inhibitors and memantine are all experimental when used for cognitive improvement in ECT patients. J0654 (injection, liothyronine, 1 mcg) is explicitly listed as not covered under this policy.
Combined ECT with other neurostimulation techniques — including transcranial direct current stimulation and repetitive transcranial magnetic stimulation — is experimental. CPT codes 90867, 90868, and 90869 (TMS treatment codes) are not covered under CPB 0445. Don't combine billing for ECT and TMS on the same claim expecting both to pay.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Catatonia | Covered | CPT 90870, 00104; F06.1 | Medical necessity required |
| Acute schizophrenic exacerbations | Covered | CPT 90870, 00104; F20.0–F20.9 | Acute exacerbation only — not treatment-resistant |
| Major depressive disorder | Covered | CPT 90870, 00104; F32.0–F33.9 | Aetna notes >20 sessions rarely medically necessary for remission; document continued need |
| Bipolar disorder | Covered | CPT 90870, 00104; F31.0–F31.9 | — |
| Mania | Covered | CPT 90870, 00104; F30.10–F30.9 | — |
| Treatment-resistant schizophrenia | Experimental | — | Explicitly excluded despite acute exacerbation coverage |
| Ultrabrief bilateral ECT | Experimental | CPT 90870 excluded for this variant | Technique exclusion, not diagnosis-based |
| Multiple monitored ECT | Experimental | — | Not covered regardless of diagnosis |
| Adjunctive ketamine during ECT | Experimental | — | Not covered |
| Autism spectrum disorders | Experimental | F84.0–F84.9 | — |
| Borderline personality disorder | Experimental | F60.3 | — |
| PTSD | Experimental | F40.00–F48.9 range | — |
| OCD | Experimental | F40.00–F48.9 range | — |
| Eating disorders | Experimental | F50.0–F50.9 | — |
| Dementia-associated agitation | Experimental | F01.50–F03.C4 | — |
| Parkinson's motor symptoms | Experimental | — | Not an all-inclusive list |
| COVID-19 neuropsychiatric complications | Experimental | — | — |
| Delirium | Experimental | — | — |
| CRPS | Experimental | — | See related CPB 0447 |
| Functional MRI for ECT outcome prediction | Experimental | CPT 70554, 70555 | Not covered for this indication |
| EEG for ECT response prediction | Experimental | — | Not covered |
| TMS combined with ECT | Experimental | CPT 90867, 90868, 90869 | Not covered under CPB 0445 |
| Liothyronine for ECT cognitive support | Experimental | HCPCS J0654 | Not covered |
| Cranial electrotherapy stimulation | Not covered | HCPCS E0732 | Not covered for listed indications |
Aetna ECT Billing Guidelines and Action Items 2026
Here are the specific steps your billing and authorization teams should take now.
| # | Action Item |
|---|---|
| 1 | Audit your active ECT charge capture before February 27, 2026. Pull all open authorizations and pending claims for ECT. Check the diagnosis codes against the covered list. If you're billing CPT 90870 for any indication outside the five covered diagnoses, those claims are at risk. |
| 2 | Train your authorization team on the schizophrenia distinction. Acute schizophrenic exacerbations (F20.0–F20.9) are covered. Treatment-resistant schizophrenia is not. The ICD-10 code alone won't distinguish them. The clinical documentation must show acute exacerbation — not just a schizophrenia diagnosis. |
| 3 | Flag all series approaching or exceeding 20 sessions. Aetna notes that more than 20 sessions in a single treatment series is rarely medically necessary for remission. Pull a report on current patients with 18 or more sessions and make sure the charts support continuation if billing beyond that threshold. |
| 4 | Remove adjunctive codes from ECT claims. CPT 70554, 70555, 90867, 90868, 90869, HCPCS J0654, and HCPCS E0732 are not covered under this policy. If your team has been bundling any of these — particularly TMS codes or functional MRI — stop now. Billing them alongside CPT 90870 will generate denials and may trigger audits. |
| 5 | Verify member-level prior authorization requirements before each series. CPB 0445 doesn't spell out universal prior auth requirements, but individual plan designs vary. For maintenance ECT — anything beyond acute phase treatment — confirm with Aetna before the sessions begin. A retroactive denial on 10 maintenance sessions is expensive and hard to appeal without advance authorization. |
| 6 | Update your denial management workflow for the expanded experimental list. With 21 experimental indications now listed explicitly, you'll want a specific denial reason code mapped to each. If a claim comes back denied for an off-label indication, your team needs to know immediately whether to appeal or write it off. Generic "not medically necessary" denials won't tell you which category triggered the rejection. |
| 7 | Talk to your compliance officer if your practice treats complex populations. If you serve patients with dementia, autism spectrum disorders, or eating disorders who receive ECT, your reimbursement exposure under this updated policy is real. The effective date of February 27, 2026 means any session billed after that date for an experimental indication will be denied. Your compliance officer should know about this before you're dealing with claim denials. |
| 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 |
|---|---|---|
| 90870 | CPT | Electroconvulsive therapy (includes necessary monitoring) — not covered for ultrabrief bilateral ECT |
| 00104 | CPT | Anesthesia for electroconvulsive therapy |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 70554 | CPT | MRI brain, functional; including test selection and administration of repetitive stimulation | Not covered — functional MRI for ECT outcome prediction is experimental |
| 70555 | CPT | MRI brain, functional; requiring physician or psychologist administration | Not covered — same indication |
| 90867 | CPT | Therapeutic repetitive TMS treatment; initial, including cortical mapping | Not covered for indications listed in CPB 0445 |
| 90868 | CPT | Therapeutic repetitive TMS treatment; subsequent delivery and management | Not covered for indications listed in CPB 0445 |
| 90869 | CPT | Therapeutic repetitive TMS treatment; subsequent motor threshold re-determination | Not covered for indications listed in CPB 0445 |
| 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 for cognitive support in ECT patients |
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 code table — not explicitly named as a covered indication in the medical necessity criteria; verify with Aetna before billing |
| 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 | Not listed as a covered indication in the policy summary's medical necessity criteria |
| F01.50–F03.C4 | Dementia | Experimental for ECT |
| F10.10–F19.99 | Mental/behavioral disorders due to psychoactive substance use | Experimental for ECT |
| F40.00–F48.9 | Anxiety, dissociative, stress-related, somatoform, other non-psychotic disorders | Experimental for ECT |
| F50.0–F50.9 | Eating disorders | Experimental for ECT |
| F60.0–F60.9 | Specific personality disorders (including F60.3, borderline PD) | Experimental for ECT |
| F84.0–F84.9 | Pervasive developmental disorders (autism spectrum) | Experimental for ECT |
| F95.0–F95.1 | Tic disorders (Tourette syndrome) | Experimental for ECT |
| F06.70–F06.71 | Mild neurocognitive disorder due to known physiological condition | Listed — verify indication |
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