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.

ECT policy

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).

ECT authorizations

Outpatient ECT authorization

  • Not required when performed by a participating physician at an in-network facility
  • Required when performed by a non-participating physician or at an out-of-network facility. Out of network providers request mental health and substance use disorder services using our authorization request forms.

Inpatient ECT authorization

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