Aetna · Clinical coverage policy

Aetna Electroconvulsive Therapy (ECT) coverage criteria

Aetna covers electroconvulsive therapy (ECT) as medically necessary for any of five diagnoses - catatonia, certain acute schizophrenic exacerbations, major depressive disorder (unipolar), bipolar disorder, or mania - with diagnosis alone being the gate (no treatment-resistance or medication-failure requirement). The policy notes that more than 20 sessions per treatment series is rarely necessary to reach remission, though less-frequent maintenance/prophylactic sessions may continue indefinitely; alternative ECT techniques (ultrabrief bilateral, multiple monitored, adjunctive ketamine), ECT for unlisted conditions, and various adjunctive/diagnostic approaches are considered experimental/investigational and not covered.

Policy CPB 0445 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0445

Prior auth

Confirm

Effective

January 1, 2026

This page reflects the coverage criteria captured from Aetna policy CPB 0445 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Electroconvulsive Therapy (ECT) (CPT 90870), and what gets it denied?

Path
Aetna covers electroconvulsive therapy (ECT) as medically necessary for any of five diagnoses - catatonia, certain acute schizophrenic exacerbations, major depressive disorder (unipolar), bipolar disorder, or mania - with diagnosis alone being the gate (no treatment-resistance or medication-failure requirement). The policy notes that more than 20 sessions per treatment series is rarely necessary to reach remission, though less-frequent maintenance/prophylactic sessions may continue indefinitely; alternative ECT techniques (ultrabrief bilateral, multiple monitored, adjunctive ketamine), ECT for unlisted conditions, and various adjunctive/diagnostic approaches are considered experimental/investigational and not covered. Coverage criteria include: Aetna considers electroconvulsive therapy (ECT) medically necessary for members diagnosed with ANY of the following conditions (diagnosis alone suffices; the policy does NOT gate on treatment-resistance, medication failure, or severity); Catatonia; Certain acute schizophrenic exacerbations; Major depressive disorder (unipolar disorder); Bipolar disorder; Mania; Maintenance/continuation ECT (no separate criteria block): Note - More than 20 sessions of ECT in a treatment series is rarely medically necessary to achieve remission; however additional, less frequent sessions may continue as prophylaxis, sometimes indefinitely. Applies to 1 code: 90870.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Aetna considers the following interventions experimental, investigational, or unproven because the effectiveness of these approaches has not been established (the following indications/techniques are not all-inclusive):; ECT technique: Multiple monitored ECT (experimental/investigational/unproven); ECT technique: Ultrabrief bilateral ECT (experimental/investigational/unproven); ECT technique: Adjunctive ketamine in ECT (experimental/investigational/unproven); ECT for addictive disorders (e.g., methamphetamine dependence) (experimental/investigational/unproven); ECT for autism spectrum disorders (experimental/investigational/unproven); ECT for autoimmune encephalitis (e.g., anti-NMDA receptor encephalitis) (experimental/investigational/unproven); ECT for body dysmorphic disorder (experimental/investigational/unproven); ECT for borderline personality disorder (experimental/investigational/unproven); ECT for complex regional pain syndrome (experimental/investigational/unproven); ECT for delirium (experimental/investigational/unproven); ECT for dementia-associated agitation and aggression (experimental/investigational/unproven); ECT for drug-resistant epilepsy (experimental/investigational/unproven); ECT for eating disorders (experimental/investigational/unproven); ECT for Lennox-Gastaut syndrome (experimental/investigational/unproven); ECT for motor symptoms associated with Parkinson's disease (experimental/investigational/unproven); ECT for neuropsychiatric complications of COVID-19 (experimental/investigational/unproven); ECT for obsessive-compulsive disorder (experimental/investigational/unproven); ECT for post-traumatic stress disorder (experimental/investigational/unproven); ECT for refractory status epilepticus (experimental/investigational/unproven); ECT for self-injurious behaviors (experimental/investigational/unproven); ECT for somatic symptom disorder (experimental/investigational/unproven); ECT for tardive dyskinesia/tardive syndromes (experimental/investigational/unproven); ECT for Tourette syndrome (tic disorders) (experimental/investigational/unproven); ECT for treatment-resistant schizophrenia (experimental/investigational/unproven); Combined ECT and other neuro-stimulation techniques (e.g., transcranial direct current stimulation, repetitive transcranial magnetic stimulation) for psychiatric disorders (experimental/investigational/unproven); Functional MRI of fronto-temporal connectivity for prediction of ECT outcome in major depression (experimental/investigational/unproven); Measurement of plasma brain-derived neurotrophic factor (BDNF) as an indicator of treatment response to ECT (experimental/investigational/unproven); Electroencephalography (EEG) for predicting clinical response to ECT in major depression (experimental/investigational/unproven); Adjunctive medications for improvement of cognitive function during ECT - ketamine, liothyronine, melatonin, opioid receptor agonists, piracetam, and prophylactic cognitive enhancers (cholinesterase inhibitors, memantine) (experimental/investigational/unproven). Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0445 — Electroconvulsive Therapy (ECT)

Coverage criteria

  • Aetna considers electroconvulsive therapy (ECT) medically necessary for members diagnosed with ANY of the following conditions (diagnosis alone suffices; the policy does NOT gate on treatment-resistance, medication failure, or severity)
  • Catatonia
  • Certain acute schizophrenic exacerbations
  • Major depressive disorder (unipolar disorder)
  • Bipolar disorder
  • Mania
  • Maintenance/continuation ECT (no separate criteria block): Note - More than 20 sessions of ECT in a treatment series is rarely medically necessary to achieve remission; however additional, less frequent sessions may continue as prophylaxis, sometimes indefinitely

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Electroconvulsive Therapy (ECT) (CPT 90870), and what gets it denied?
Aetna covers electroconvulsive therapy (ECT) as medically necessary for any of five diagnoses - catatonia, certain acute schizophrenic exacerbations, major depressive disorder (unipolar), bipolar disorder, or mania - with diagnosis alone being the gate (no treatment-resistance or medication-failure requirement). The policy notes that more than 20 sessions per treatment series is rarely necessary to reach remission, though less-frequent maintenance/prophylactic sessions may continue indefinitely; alternative ECT techniques (ultrabrief bilateral, multiple monitored, adjunctive ketamine), ECT for unlisted conditions, and various adjunctive/diagnostic approaches are considered experimental/investigational and not covered. Coverage criteria include: Aetna considers electroconvulsive therapy (ECT) medically necessary for members diagnosed with ANY of the following conditions (diagnosis alone suffices; the policy does NOT gate on treatment-resistance, medication failure, or severity); Catatonia; Certain acute schizophrenic exacerbations; Major depressive disorder (unipolar disorder); Bipolar disorder; Mania; Maintenance/continuation ECT (no separate criteria block): Note - More than 20 sessions of ECT in a treatment series is rarely medically necessary to achieve remission; however additional, less frequent sessions may continue as prophylaxis, sometimes indefinitely. Applies to 1 code: 90870. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Aetna considers the following interventions experimental, investigational, or unproven because the effectiveness of these approaches has not been established (the following indications/techniques are not all-inclusive):; ECT technique: Multiple monitored ECT (experimental/investigational/unproven); ECT technique: Ultrabrief bilateral ECT (experimental/investigational/unproven); ECT technique: Adjunctive ketamine in ECT (experimental/investigational/unproven); ECT for addictive disorders (e.g., methamphetamine dependence) (experimental/investigational/unproven); ECT for autism spectrum disorders (experimental/investigational/unproven); ECT for autoimmune encephalitis (e.g., anti-NMDA receptor encephalitis) (experimental/investigational/unproven); ECT for body dysmorphic disorder (experimental/investigational/unproven); ECT for borderline personality disorder (experimental/investigational/unproven); ECT for complex regional pain syndrome (experimental/investigational/unproven); ECT for delirium (experimental/investigational/unproven); ECT for dementia-associated agitation and aggression (experimental/investigational/unproven); ECT for drug-resistant epilepsy (experimental/investigational/unproven); ECT for eating disorders (experimental/investigational/unproven); ECT for Lennox-Gastaut syndrome (experimental/investigational/unproven); ECT for motor symptoms associated with Parkinson's disease (experimental/investigational/unproven); ECT for neuropsychiatric complications of COVID-19 (experimental/investigational/unproven); ECT for obsessive-compulsive disorder (experimental/investigational/unproven); ECT for post-traumatic stress disorder (experimental/investigational/unproven); ECT for refractory status epilepticus (experimental/investigational/unproven); ECT for self-injurious behaviors (experimental/investigational/unproven); ECT for somatic symptom disorder (experimental/investigational/unproven); ECT for tardive dyskinesia/tardive syndromes (experimental/investigational/unproven); ECT for Tourette syndrome (tic disorders) (experimental/investigational/unproven); ECT for treatment-resistant schizophrenia (experimental/investigational/unproven); Combined ECT and other neuro-stimulation techniques (e.g., transcranial direct current stimulation, repetitive transcranial magnetic stimulation) for psychiatric disorders (experimental/investigational/unproven); Functional MRI of fronto-temporal connectivity for prediction of ECT outcome in major depression (experimental/investigational/unproven); Measurement of plasma brain-derived neurotrophic factor (BDNF) as an indicator of treatment response to ECT (experimental/investigational/unproven); Electroencephalography (EEG) for predicting clinical response to ECT in major depression (experimental/investigational/unproven); Adjunctive medications for improvement of cognitive function during ECT - ketamine, liothyronine, melatonin, opioid receptor agonists, piracetam, and prophylactic cognitive enhancers (cholinesterase inhibitors, memantine) (experimental/investigational/unproven). Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Electroconvulsive Therapy (ECT)?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Electroconvulsive Therapy (ECT)?
Policy exclusions and limitations: Aetna considers the following interventions experimental, investigational, or unproven because the effectiveness of these approaches has not been established (the following indications/techniques are not all-inclusive):; ECT technique: Multiple monitored ECT (experimental/investigational/unproven); ECT technique: Ultrabrief bilateral ECT (experimental/investigational/unproven); ECT technique: Adjunctive ketamine in ECT (experimental/investigational/unproven); ECT for addictive disorders (e.g., methamphetamine dependence) (experimental/investigational/unproven); ECT for autism spectrum disorders (experimental/investigational/unproven); ECT for autoimmune encephalitis (e.g., anti-NMDA receptor encephalitis) (experimental/investigational/unproven); ECT for body dysmorphic disorder (experimental/investigational/unproven); ECT for borderline personality disorder (experimental/investigational/unproven); ECT for complex regional pain syndrome (experimental/investigational/unproven); ECT for delirium (experimental/investigational/unproven); ECT for dementia-associated agitation and aggression (experimental/investigational/unproven); ECT for drug-resistant epilepsy (experimental/investigational/unproven); ECT for eating disorders (experimental/investigational/unproven); ECT for Lennox-Gastaut syndrome (experimental/investigational/unproven); ECT for motor symptoms associated with Parkinson's disease (experimental/investigational/unproven); ECT for neuropsychiatric complications of COVID-19 (experimental/investigational/unproven); ECT for obsessive-compulsive disorder (experimental/investigational/unproven); ECT for post-traumatic stress disorder (experimental/investigational/unproven); ECT for refractory status epilepticus (experimental/investigational/unproven); ECT for self-injurious behaviors (experimental/investigational/unproven); ECT for somatic symptom disorder (experimental/investigational/unproven); ECT for tardive dyskinesia/tardive syndromes (experimental/investigational/unproven); ECT for Tourette syndrome (tic disorders) (experimental/investigational/unproven); ECT for treatment-resistant schizophrenia (experimental/investigational/unproven); Combined ECT and other neuro-stimulation techniques (e.g., transcranial direct current stimulation, repetitive transcranial magnetic stimulation) for psychiatric disorders (experimental/investigational/unproven); Functional MRI of fronto-temporal connectivity for prediction of ECT outcome in major depression (experimental/investigational/unproven); Measurement of plasma brain-derived neurotrophic factor (BDNF) as an indicator of treatment response to ECT (experimental/investigational/unproven); Electroencephalography (EEG) for predicting clinical response to ECT in major depression (experimental/investigational/unproven); Adjunctive medications for improvement of cognitive function during ECT - ketamine, liothyronine, melatonin, opioid receptor agonists, piracetam, and prophylactic cognitive enhancers (cholinesterase inhibitors, memantine) (experimental/investigational/unproven). Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0445 — Electroconvulsive Therapy (ECT)

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0445 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.