Electroconvulsive therapy

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 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.

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 Behavioral Health authorization form.

Inpatient ECT authorization

Inpatient ECT requests are reviewed in conjunction with review of the inpatient admission. Please attach the request to the Inpatient Authorization in GuidingCare, or if you're a non-participating provider, please fill out our Behavioral Health authorization form, attach necessary clinical information and fax to our Behavioral Health department at 616.975.0249.