ELECTROCONVULSIVE THERAPY (ECT) (REQUIRES PREAUTHORIZATION)

I.210





I.210 ELECTROCONVULSIVE THERAPY (ECT) (REQUIRES PREAUTHORIZATION)


Policy

INTERQUAL CRITERIA



InterQual Clinical Criteria

Dates

  • Original Effective
    03-01-2022
  • Last Review
    02-05-2025
  • Next Review
    02-08-2026

Description

Electroconvulsive Therapy (ECT) is a procedure which involves brief electrical stimulation to the brain while the patient is under anesthesia. The subset includes criteria for acute, also called short-term or index, ECT and continuation or maintenance ECT. ECT is usually done on an outpatient basis although inpatient may be required when a patient is a danger to self or others or is gravely disabled. Continuation ECT (cECT) is performed within the first 6 months after initial, or index, course of ECT treatment and maintenance (mECT) is performed after 6 months.



Recommended Medical Records

  • History and Physical Report
  • Office Notes
  • Treatment plan including frequency and total number of sessions requested
  • Current medication list and previously tried and failed medications


    • Quick Code Search

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    Codes

          
              Full Description
                Anesthesia for electroconvulsive therapy
          
              Full Description
                Electroconvulsive therapy (includes necessary monitoring)




    References

    2019

    Huang CJ, Lin CH, Wu JI, Yang WC. The Relationship Between Depression Symptoms and Anxiety Symptoms During Acute ECT for Patients With Major Depressive Disorder. Int J Neuropsychopharmacol. 2019 Oct 1;22(10):609-615. doi: 10.1093/ijnp/pyz038. PMID: 31282929; PMCID: PMC6822139.
    2018

    Ross EL, Zivin K, Maixner DF. Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States. JAMA Psychiatry. 2018;75(7):713–722. doi:10.1001/jamapsychiatry.2018.0768
    2019

    Bahji A, Hawken ER, Sepehry AA, Cabrera CA, Vazquez G. ECT beyond unipolar major depression: systematic review and meta-analysis of electroconvulsive therapy in bipolar depression. Acta Psychiatr Scand. 2019 Mar;139(3):214-226. doi: 10.1111/acps.12994. Epub 2018 Dec 16. PMID: 30506992.
    2010

    Consoli A, Benmiloud M, Wachtel L, Dhossche D, Cohen D, Bonnot O. Electroconvulsive therapy in adolescents with the catatonia syndrome: efficacy and ethics. J ECT. 2010 Dec;26(4):259-65. doi: 10.1097/YCT.0b013e3181fb3924. PMID: 21099377.
    2017

    Sinha P, Goyal P, Andrade C. A Meta-review of the Safety of Electroconvulsive Therapy in Pregnancy. J ECT. 2017 Jun;33(2):81-88. doi: 10.1097/YCT.0000000000000362. PMID: 28009621.
    2020

    Niu Y, Ye D, You Y, Wu J. Prophylactic cognitive enhancers for improvement of cognitive function in patients undergoing electroconvulsive therapy: A systematic review and meta-analysis. Medicine (Baltimore). 2020 Mar;99(11):e19527. doi: 10.1097/MD.0000000000019527. PMID: 32176105; PMCID: PMC7440112.
    1985

    U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Electroconvulsive Therapy (Archived). National Institutes of Health Consensus Development Conference Statement. Bethesda, MD: NIH (1985 June 10-12). PMID 3908919

     
    2015

    Practice Guidelines for the Treatment of Patients with Major Depressive Disorder. Third Edition. American Psychiatric Association, (Revised 2010; Reaffirmed 2015). Available at <https://www.guideline.gov>.
    1999

    American Psychiatric Association. Practice guideline for the treatment of patients with delirium. Am J Psychiatry. 1999; 156(5 Suppl):1-20. PMID 10327941
    2004

    American Psychiatric Association. Guideline Watch: Practice Guideline for the treatment of patients with delirium (2004). Available at <http://psychiatryonline.org>.
    2009

    National Institute for Health and Care Excellence, Guidance on the use of Electroconvulsive Therapy, April 2003 (modified October 2009). Available at <https://www.nice.org>.
    2009

    National Institute for Health and Care Excellence, Depression in adults: The treatment and management of depression in adults, October 2009. Available at <https://www.nice.org> 

    Revisions

    06-15-2025

    Using InterQual criteria.
    02-14-2024

    Policy reviewed at Medical Policy Committee meeting on 02/07/2024 – no changes to policy