Electroconvulsive therapy (ECT)

Coverage varies depending on plan

Applies to: 

Group HMO, EPO, POS and PPO plans

Individual MyPriority® HMO, POS and PPO plans 

Medicare Advantage plans

Definition

From the Mayo Clinic: Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses.

Medical policy

Electroconvulsive Therapy - 91554

ECT authorizations

Medical necessity criteria

The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for ECT, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies (above).

Outpatient ECT authorization

Inpatient ECT authorization

Inpatient ECT requests are reviewed in conjunction with review of the inpatient admission.