Optum Clarifies Payment for Anesthesia Services Provided During Electroconvulsive Therapy

Optum has reaffirmed that anesthesia services are a critical and medically necessary component of the safe and effective delivery of electroconvulsive therapy (ECT). In its response to the American Society of Anesthesiologists (ASA’s) request for a separate payment for the anesthesia services during ECT, the company acknowledged the essential role anesthesiologists play in patient evaluation, intra-procedural management, and post-procedure recovery, and acknowledges that these services are clinically distinct when provided by qualified anesthesia professionals.

Optum further clarified that anesthesia services are eligible for separate payment when furnished by a provider who is distinct from the procedural physician and when the services are separately identifiable.

At the same time, Optum noted that payment for ECT-related services in contracted settings depends on the terms of the facility's agreement with Optum and generally falls into one of two categories:

Bundled (Inclusive) Arrangements

• The negotiated facility payment may include professional services such as anesthesia and psychiatric care.
• The facility receives a bundled payment and is responsible for compensating participating clinicians.
• These arrangements reflect contractual agreements and do not imply that anesthesia services are not clinically distinct or separately billable under other circumstances.

Unbundled (Exclusive) Arrangements

• Professional services are excluded from the facility payment.
• Anesthesia and psychiatric services may be billed and paid separately, subject to applicable coding, documentation, and contractual requirements.

Coding and Billing Guidance

In the absence of a contractual facility agreement, Optum applies nationally recognized coding standards, including CPT guidance and CMS-aligned billing principles.

• CPT 00104 (Anesthesia for Electroconvulsive Therapy) and CPT 90870 (Electroconvulsive Therapy) represent distinct professional services.
• When provided by separate physicians acting within their respective scopes of practice, both services may be reported on the same date of service.
• Payment is based on whether services are distinct, separately identifiable, and not otherwise included in a bundled or pre-negotiated payment arrangement.

Important Billing Limitation

Under Optum's guidelines, CPT codes 00104 and 90870 may not be billed together when submitted by the same physician specialty, as the anesthesia component is considered included in the procedure. However, when anesthesia and ECT services are performed by different physician specialties, both codes may be reported and considered for reimbursement consistent with national coding standards.

Implications for Anesthesiologists

For anesthesiologists practicing in contracted environments, reimbursement may be directed either to the facility or directly to the anesthesia provider depending on the terms of the applicable agreement. In non-contracted settings or under unbundled arrangements, anesthesia services may be reimbursed separately when appropriately billed, supported by documentation, and provided in accordance with established coding standards.

ASA encourages Anesthesiologists to review facility contracts and payment arrangements to understand how ECT-related anesthesia services are compensated within their practice setting.