CMS Electrical Aversion Therapy Coverage Policy: What Billing Teams Need to Know (NCD 31)

The Centers for Medicare & Medicaid Services (CMS) has issued a modified determination under National Coverage Determination (NCD) 31, addressing electrical aversion therapy as a treatment for alcoholism. This policy — which covers electroversion therapy, electro-shock therapy, and noxious faradic stimulation — maintains a blanket non-coverage position, citing a lack of demonstrated safety and effectiveness. If your practice or facility has submitted or is considering submitting claims for this service under Medicare, here is exactly what the policy says and what your team should do next.

What CMS NCD 31 Actually Covers — and What It Doesn't

The short answer: CMS does not cover electrical aversion therapy for alcoholism treatment under Medicare. Full stop.

NCD 31 defines electrical aversion therapy as a behavior modification technique designed to foster abstinence from alcohol by creating conditioned aversions to the taste, smell, and sight of alcoholic beverages through electric stimulation. The therapy goes by several clinical names — electroversion therapy, electro-shock therapy, and noxious faradic stimulation — all of which fall under the same non-coverage determination.

CMS's stated rationale is direct: the agency has determined that electrical aversion therapy "has not been shown to be safe and effective" and therefore excludes it from Medicare coverage entirely. This is not a coverage-with-conditions situation. There are no clinical criteria that unlock reimbursement, no prior authorization pathway that could result in approval, and no patient population for whom CMS considers this treatment covered.

This falls under the Medicare benefit category of Physicians' Services, meaning the non-coverage applies regardless of the setting in which the therapy is delivered.

Understanding the "Modified" Designation for NCD 31

A "modified" policy update doesn't always mean the coverage position changed — and that's the case here. Billing teams should understand that CMS periodically reviews and reissues NCDs as part of ongoing policy maintenance. The modification to NCD 31 reflects an administrative update rather than a substantive shift in coverage criteria.

The underlying determination — that electrical aversion therapy is not covered — remains unchanged. The modification date of March 12, 2026, signals that this policy has been reviewed and reaffirmed in its current form.

That said, any time CMS touches an NCD, your team should treat it as an opportunity to audit your billing practices against the current policy text, confirm your payer contracts are aligned, and make sure no claims are going out the door for a non-covered service.

Clinical Context: Why CMS Excludes Electrical Aversion Therapy

Electrical aversion therapy occupies a narrow and contested corner of addiction treatment. The theoretical basis — pairing alcohol-related stimuli with an aversive electrical stimulus to create conditioned avoidance — draws from behavioral conditioning frameworks. However, the clinical evidence base has never been sufficient to meet Medicare's coverage standards.

CMS cross-references NCD 31 with three related sections of the NCD Manual:

• §30.1 — Acupuncture
• §130.1 — Biofeedback therapy
• §130.3 — Biofeedback therapy for the treatment of urinary incontinence

These cross-references are instructive. They situate electrical aversion therapy alongside other behavioral and stimulation-based interventions that CMS has historically scrutinized closely for evidence of clinical efficacy before extending coverage. The common thread is that CMS requires robust evidence of safety and effectiveness — and for electrical aversion therapy, that evidence hasn't materialized.

For practices operating in addiction medicine or behavioral health, this means that patients seeking this treatment for alcohol use disorder will need to look outside Medicare for any potential coverage — or pay out of pocket.

Affected Codes

This policy does not list specific CPT or HCPCS codes. CMS has not assigned procedure codes to electrical aversion therapy under NCD 31, which itself is clinically significant: the absence of assigned codes reflects the service's non-covered status and its limited use in mainstream clinical practice.

No covered codes are identified under this policy.

Non-covered services — NCD 31:

Related ICD-10 Diagnosis Codes:

No ICD-10-CM codes are specified in the policy document. The policy applies to electrical aversion therapy delivered in the context of alcoholism treatment broadly, without listing specific diagnosis codes.

If your billing team is working with claims that involve alcohol use disorder diagnoses (such as F10.x codes in the ICD-10-CM system), be aware that NCD 31 would prohibit coverage for electrical aversion therapy regardless of the underlying diagnosis code submitted.

What Your Billing Team Should Do