TL;DR: The Centers for Medicare & Medicaid Services modified NCD 31, its coverage policy for electrical aversion therapy for alcoholism treatment, effective January 9, 2026. The position is unchanged in substance — this therapy is not covered under Medicare — but billing teams should treat this update as a formal trigger to audit any claims or charge capture entries tied to this service.
NCD 31 in the Medicare system covers electroversion therapy, electro-shock therapy, and noxious faradic stimulation used to treat alcohol dependence. The Centers for Medicare & Medicaid Services classifies this service as not safe and effective. No CPT or HCPCS codes are listed in the policy document.
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Electrical Aversion Therapy for Treatment of Alcoholism |
| Policy Code | NCD 31 |
| Change Type | Modified |
| Effective Date | 2026-01-09 |
| Impact Level | Low — coverage status unchanged, but denial risk remains if claims are submitted |
| Specialties Affected | Psychiatry, addiction medicine, behavioral health, internal medicine |
| Key Action | Confirm no active charge capture entries exist for electrical aversion therapy; if your practice bills this service, expect automatic claim denial |
CMS Electrical Aversion Therapy Coverage Criteria and Medical Necessity Requirements 2026
The CMS electrical aversion therapy coverage policy under NCD 31 is a flat exclusion. There are no medical necessity criteria to meet. There is no documentation pathway that unlocks coverage. There is no prior authorization process that changes the outcome.
CMS defines electrical aversion therapy as a behavior modification technique. The goal is to create conditioned aversions to the taste, smell, and sight of alcohol through electric stimulation. The therapy goes by several names in the literature — electroversion therapy, electro-shock therapy, and noxious faradic stimulation — and NCD 31 covers all of them in its exclusion.
The official CMS position: this therapy has not been shown to be safe and effective. That language is a hard stop under Medicare policy. When CMS uses those exact words, no amount of supporting documentation or clinical justification produces reimbursement.
Whether Medicare electrical aversion therapy coverage will ever change depends on whether CMS receives a formal coverage reconsideration request supported by new clinical evidence. As of the January 9, 2026 effective date of this modification, no such reconsideration is underway.
CMS Electrical Aversion Therapy Exclusions and Non-Covered Indications
The entire service is excluded. That is the policy. There are no covered subsets, no approved patient populations, and no clinical scenarios where Medicare pays for this.
This matters in practice because behavioral health billing is already complicated. Addiction medicine practices sometimes bill a range of therapeutic modalities, and a charge capture system that includes electrical aversion therapy as an option — even a rarely used one — creates claim denial exposure every time someone accidentally selects it.
Cross-references in NCD 31 point to three related sections of the NCD Manual: §30.1, §130.1, and §130.3. Those sections address electroconvulsive therapy and other behavioral health treatment policies. Review those if your practice bills electroconvulsive therapy (ECT) — the policies are related but distinct, and ECT has its own separate coverage rules.
The real issue here is scope creep in charge capture. If your EHR or practice management system has a charge entry for "aversion therapy" or any of the synonymous terms — electroversion, electro-shock, faradic stimulation — it should be flagged as a Medicare non-covered service. One misclick and your billing team is chasing a denial.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Electrical aversion therapy for alcohol use disorder (electroversion therapy) | Not Covered | No codes listed in policy | CMS exclusion — not safe and effective per NCD 31 |
| Electro-shock therapy for alcoholism treatment | Not Covered | No codes listed in policy | Same exclusion; distinct from ECT for psychiatric conditions |
| Noxious faradic stimulation for alcohol dependence | Not Covered | No codes listed in policy | All forms of electrical aversion therapy are excluded |
CMS Electrical Aversion Therapy Billing Guidelines and Action Items 2026
This policy modification took effect January 9, 2026. It does not change coverage — the service has been excluded for years. What it does is reset the clock on your internal review obligation. Treat the effective date as a compliance checkpoint.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture now. Search your EHR and practice management system for any charge entries associated with electrical aversion therapy, electroversion therapy, electro-shock therapy, or noxious faradic stimulation. Remove or flag them as Medicare non-covered. |
| 2 | Pull any claims submitted since January 1, 2025. If your practice billed anything in this category to Medicare in the last year, review those claims. Check whether they resulted in denials, improper payments, or were written off without follow-up. |
| 3 | Update your superbill and fee schedule references. If electrical aversion therapy billing appears anywhere in your charge description master or superbill — even as a placeholder — mark it explicitly as Medicare-excluded under NCD 31. |
| 4 | Do not attempt prior authorization as a workaround. This exclusion does not have a prior authorization pathway. CMS will not approve this service pre-service or post-service. Submitting a prior auth request wastes time and does not change the outcome. |
| 5 | Review the cross-referenced NCD sections. NCD §30.1, §130.1, and §130.3 govern related behavioral health services. If you bill electroconvulsive therapy or other behavioral modification services, confirm those billing guidelines are current and separate from this exclusion. |
| 6 | Brief your clinical staff on the distinction. Electroconvulsive therapy (ECT) for psychiatric conditions is a different service with different coverage rules. If your clinicians document or order "electro-shock therapy" in any context, confirm that documentation language cannot be confused with the excluded electrical aversion therapy under NCD 31. |
If your practice has billed this service to Medicare and received payment — even accidentally — talk to your compliance officer before January 9, 2026 passes without a self-audit. Improper payments carry repayment obligations, and the modification of this NCD is the kind of event that triggers contractor review activity.
| 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 Electrical Aversion Therapy Under NCD 31
The policy document for NCD 31 does not list specific CPT, HCPCS Level II, or ICD-10-CM codes. This is common for older NCDs that predate the current coding structure or apply to services so rarely billed that no specific code mapping exists.
Not Covered — All Electrical Aversion Therapy Services
| Service Description | Code Status | Notes |
|---|---|---|
| Electroversion therapy for alcohol dependence | No specific CPT/HCPCS listed | Excluded under NCD 31; submit no claim to Medicare |
| Electro-shock therapy for alcoholism | No specific CPT/HCPCS listed | Excluded under NCD 31 |
| Noxious faradic stimulation for alcohol treatment | No specific CPT/HCPCS listed | Excluded under NCD 31 |
Because no codes are defined in the policy, any claim submitted to Medicare for these services risks denial based on the service description and diagnosis. Medicare Administrative Contractor (MAC) edits may flag claims by description, revenue code, or unlisted procedure code — not just by CPT. Electrical aversion therapy billing under an unlisted code does not sidestep this exclusion.
If you believe a specific CPT or HCPCS code maps to these services and you're unsure how it will process, contact your MAC before submitting. Do not use a related-but-not-identical code and hope for the best. A local coverage determination (LCD) from your MAC may provide additional guidance if your regional contractor has addressed this separately.
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