Understanding ECT Services
Electroconvulsive Therapy (ECT) is a specialized psychiatric treatment where small electric currents are passed through the brain to trigger brief, controlled seizures. It’s primarily used for patients with severe depression, bipolar disorder, catatonia, or treatment-resistant mental illnesses when other therapies or medications are ineffective.
ECT is typically performed under anesthesia in a controlled medical setting and requires coordination between psychiatrists, anesthesiologists, and nursing staff.
Because of its clinical complexity, ECT billing involves multiple CPT codes (e.g., 90870, 00104) and strict documentation standards to meet payer compliance guidelines.
⚠️ Why ECT Claims Get Denied
Even though ECT is a medically necessary and evidence-based treatment, many claims are denied or delayed due to documentation and coding errors. Below are the most common denial reasons seen across payers such as BCBS, Aetna, and Medicare:
1. Missing or Incorrect Diagnosis Codes
ECT is reimbursed only for certain approved psychiatric diagnoses (e.g., F32.2, F33.2, F31.5, F06.3, etc.).
If the diagnosis on the claim does not match payer medical necessity criteria, the claim is rejected or flagged for review.
2. Invalid or Missing Authorization
Most commercial payers require prior authorization before ECT sessions begin.
Failure to obtain or renew authorization for each treatment series leads to immediate denials under “no authorization on file.”
3. Incorrect CPT or Modifier Usage
Common CPT codes for ECT:
- 90870 – Electroconvulsive therapy (single session, with or without anesthesia)
- 00104 – Anesthesia for ECT (when billed by the anesthesiologist)
Errors occur when providers:
- Bill 90870 and 00104 under the same NPI
- Omit modifier 59 when required to separate anesthesia and procedure
- Use global billing instead of separate professional/facility claims
4. Incomplete Clinical Documentation
Insurance carriers often request supporting notes such as:
- Psychiatric evaluation
- Treatment plan
- Informed consent documentation
- Session reports and anesthesia records
Missing these can trigger a “records requested” status or medical necessity denial.
5. Billing Under the Wrong Provider Type
ECT must be billed by a licensed psychiatrist or a credentialed behavioral health facility.
If a claim is submitted under an unqualified rendering provider or a non-credentialed location, it will automatically reject.
6. Coordination Errors Between Psychiatry and Anesthesia Billing
ECT services typically involve two billing entities — the psychiatrist for the therapy and the anesthesiologist for sedation.
Claims often deny when:
- The same provider bills both services without clarification
- NPI or taxonomy conflicts occur between the two specialties
💰 How ECT Claim Denials Impact Your Practice
Denied or delayed ECT claims can result in:
- Cash flow interruptions for psychiatric practices and behavioral health centers
- Loss of time due to repeated appeal cycles
- Compliance risks if coding doesn’t align with payer documentation rules
- Patient dissatisfaction if authorizations or benefits are mishandled
🤝 How Solubillix Helps Providers Prevent ECT Denials
At Solubillix, we specialize in behavioral health and ECT billing — helping practices simplify the process, reduce denials, and maximize reimbursements.
Here’s how we support your ECT billing operations:
✅ 1. Pre-Authorization & Verification Support
We handle eligibility and pre-certification for every ECT session, ensuring payer approval before treatment begins. Our verification team confirms diagnosis coverage, treatment limits, and documentation requirements.
✅ 2. Accurate Coding & Modifier Review
Our certified coders validate CPT combinations such as 90870, 00104, and 95970–95983 when applicable, with the correct modifiers and provider taxonomy to prevent payer edits.
✅ 3. Clinical Documentation Alignment
We help your team ensure each claim is backed by required documentation:
- Psychiatric notes
- Anesthesia records
- Session details
- Consent and follow-up reports
This ensures compliance and supports medical necessity validation during audits.
✅ 4. Real-Time Denial Tracking
Solubillix provides a denial analytics dashboard to identify patterns — whether payer-specific (e.g., BCBS authorization denials) or documentation-based — allowing faster resubmission.
✅ 5. Payer Communication & Appeals
Our dedicated claim follow-up team works directly with payers to resolve rejections and appeal medical necessity denials, shortening your revenue cycle timeline.
✅ 6. Education & Compliance Training
We train your staff on payer-specific ECT documentation and pre-auth protocols, preventing recurring errors and ensuring long-term compliance.
🌟 Why Choose Solubillix
With deep expertise in psychiatry, behavioral health, and complex procedure billing, Solubillix helps providers:
- Reduce ECT claim denials by up to 40%
- Shorten payment turnaround time
- Improve compliance with BCBS, Aetna, Cigna, and Medicare guidelines
- Free up clinical teams to focus on patient care instead of claim management
🧾 Final Thoughts
ECT is a life-saving therapy for many patients — but billing it correctly requires precision, compliance, and payer-specific knowledge.
With Solubillix as your billing partner, you can ensure every ECT session is authorized, coded, and reimbursed accurately — eliminating preventable denials and keeping your psychiatric practice financially healthy.
