Electroconvulsive Therapy (CPB 0445, reviewed 2026-07-29)
Summary
Aetna considers electroconvulsive therapy medically necessary for members with bipolar disorder, catatonia, certain acute schizophrenic or schizoaffective disorder exacerbations, major depressive disorder, mania, severe or refractory neuroleptic malignant syndrome, or treatment-resistant schizophrenia as an adjunct to antipsychotic therapy, when the member is at least 12 years old and meets one of six listed selection criteria. Multiple monitored ECT, ultrabrief bilateral ECT and adjunctive ketamine in ECT are considered experimental, investigational or unproven, as is ECT for a long list of other indications such as dysthymic disorder, dementia-associated agitation, post-traumatic stress disorder and obsessive-compulsive disorder. CPT 00104 and 90870 are covered when the selection criteria are met, 90870 is not covered for ultrabrief bilateral ECT, and several transcranial magnetic stimulation, functional MRI, HCPCS E0732 and HCPCS J0654 codes are not covered for the indications listed in the policy.
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