CommercialCoverageMedium impact
Electroconvulsive Therapy (BSC8.09)
Blue Shield of California·CA · Psychiatry, Anesthesiology·Medical Policy
Effective date
May 1, 2026
We identified it
May 1, 2026
Summary
Blue Shield of California has established a new medical policy (BSC8.09) defining coverage criteria for Electroconvulsive Therapy (ECT), including specific requirements for acute, continued, and maintenance ECT treatments. The policy requires patients to be at least 13 years old with specific psychiatric conditions and mandates pre-ECT evaluations and standardized rating scale documentation.
Action Required
Before May 1, 2026: Billing team must update prior authorization requirements for ECT procedures (CPT 90870, 00104, 4066F) to ensure all Blue Shield of California claims include required documentation: psychiatric evaluation, standardized rating scale scores, medication trial history, and treatment plan. Update EMR templates to capture all required clinical criteria including age verification (13+), qualifying conditions, and treatment response documentation.