Summary & Overview
CPT 00104: Anesthesia for Electroconvulsive Therapy
CPT code 00104 covers anesthesia services for patients undergoing electroconvulsive therapy, a procedure frequently used in the management of severe psychiatric disorders. This code is nationally recognized and utilized by anesthesiology providers in both hospital and ambulatory surgical center settings. The publication examines coverage and policy considerations from major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into the clinical context of CPT code 00104, including its role in facilitating safe anesthesia care during electroconvulsive therapy. The summary provides an overview of payer coverage, typical sites of service, and associated billing practices. Key benchmarks and policy updates relevant to anesthesiology and procedural billing are highlighted, offering a comprehensive understanding of how this code is applied in practice. The publication also addresses related codes and modifiers, supporting accurate reporting and compliance in medical billing. This resource is designed for healthcare professionals, administrators, and policy analysts seeking clarity on anesthesia billing for electroconvulsive therapy.
CPT Code Overview
CPT code 00104 is designated for anesthesia services provided during electroconvulsive therapy. This code is used by anesthesiology professionals to report the administration and management of anesthesia specifically for patients undergoing electroconvulsive therapy procedures. The typical site of service for CPT code 00104 includes hospital settings or ambulatory surgical centers (Place of Service codes 22 or 24). This code is integral to ensuring safe and effective anesthesia care during a procedure that is commonly used in the treatment of certain psychiatric conditions.
Clinical & Coding Specifications
Clinical Context
A patient is scheduled for electroconvulsive therapy (ECT) in a hospital or ambulatory surgical center. ECT is typically performed for severe psychiatric conditions such as major depressive disorder, bipolar disorder, or schizophrenia when other treatments have not been effective. Prior to the procedure, an anesthesiologist evaluates the patient, reviews medical history, and ensures the patient is fit for anesthesia. On the day of the procedure, the anesthesiologist administers anesthesia to induce unconsciousness and muscle relaxation, allowing the ECT to be performed safely. The anesthesia service is coded with CPT code 00104. The workflow includes pre-anesthesia assessment, administration of anesthesia, monitoring during the procedure, and post-anesthesia care.
Coding Specifications
-
Modifier
QS: Indicates that monitored anesthesia care (MAC) was provided. Used when the anesthesiologist is present and monitoring the patient throughout the procedure. -
Modifier
P1: Denotes a normal healthy patient. Used to indicate the physical status of the patient receiving anesthesia.
| Modifier Code | Description |
|---|---|
QS | Monitored anesthesia care service |
P1 | A normal healthy patient |
Provider Taxonomies:
207L00000X- Anesthesiology: Physicians specializing in anesthesia administration.207LA0401X- Pain Medicine (Anesthesiology): Anesthesiologists with a focus on pain management.207LP2900X- Pediatric Anesthesiology: Anesthesiologists specializing in pediatric patients.
Related Diagnoses
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L02.211- Cutaneous abscess of abdominal wall- This diagnosis may be relevant if the patient has an active infection or abscess that could impact anesthesia risk or perioperative management during ECT.
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L03.311- Cellulitis of abdominal wall- Cellulitis may be a comorbidity affecting anesthesia planning, as infection can alter patient stability and response to anesthesia.
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L98.9- Disorder of skin and subcutaneous tissue, unspecified- This code covers unspecified skin disorders, which may be noted in the patient's medical history and considered during anesthesia assessment for ECT.
These diagnoses are not directly related to the ECT procedure but may represent comorbidities or conditions that influence anesthesia care and documentation.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
00100 | Anesthesia for procedures on salivary glands, including biopsy | Alternative anesthesia service for head/neck procedures |
00102 | Anesthesia for procedures involving plastic repair of cleft lip | Alternative anesthesia for facial reconstructive surgery |
00103 | Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) | Alternative anesthesia for eyelid surgery |
00120 | Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified | Alternative anesthesia for ear procedures |
00124 | Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy | Alternative anesthesia for ear procedures (otoscopy) |
00126 | Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy | Alternative anesthesia for ear procedures (tympanotomy) |
00140 | Anesthesia for procedures on eye; not otherwise specified | Alternative anesthesia for eye procedures |
00142 | Anesthesia for procedures on eye; lens surgery | Alternative anesthesia for lens surgery |
00144 | Anesthesia for procedures on eye; corneal transplant | Alternative anesthesia for corneal transplant |
00145 | Anesthesia for procedures on eye; vitreoretinal surgery | Alternative anesthesia for vitreoretinal surgery |
00147 | Anesthesia for procedures on eye; iridectomy | Alternative anesthesia for iridectomy |
00148 | Anesthesia for procedures on eye; ophthalmoscopy | Alternative anesthesia for ophthalmoscopy |
00160 | Anesthesia for procedures on nose and accessory sinuses; not otherwise specified | Alternative anesthesia for nasal procedures |
00162 | Anesthesia for procedures on nose and accessory sinuses; radical surgery | Alternative anesthesia for radical nasal surgery |
00164 | Anesthesia for procedures on nose and accessory sinuses; biopsy, soft tissue | Alternative anesthesia for nasal soft tissue biopsy |
These codes represent anesthesia services for various head, neck, and facial procedures. They are alternatives to 00104 and are not typically used together, but may be selected based on the specific surgical procedure being performed.
National Reimbursement Benchmarks
National mean rates for CPT code 00104 show that Blue Cross Blue Shield and Cigna have the highest average reimbursement, at $241.50 and $248.20 respectively, while UnitedHealth Group is notably lower at $65.57. The BUCA (average commercial) mean rate stands at $130.99, which is significantly higher than UnitedHealth Group but lower than the other major commercial payers. Medicare data is not available in the input.
Rate dispersion varies considerably across payers. UnitedHealth Group has the tightest range between the 25th and 75th percentiles ($75.50 - $50.20 = $25.30), indicating less variability in rates. In contrast, Cigna exhibits the widest spread ($348.00 - $89.00 = $259.00), suggesting substantial variation in contracted rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 00104, particularly with Blue Cross Blue Shield, where the 75th percentile rate ($300.00) is $74.20 higher than the 25th percentile ($225.80). This spread is much larger than that seen with Aetna, Cigna, and UnitedHealth Group, which all have minimal rate variation between percentiles. Compared to national averages, Alaska's mean rates for Blue Cross Blue Shield and Aetna are notably higher, while Cigna and UnitedHealth Group are below their respective national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the significant differences in reimbursement levels across payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00104 in Alaska, with a mean rate of $269.10.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- Alaska's mean rates for most payers are higher than national benchmarks, except for Cigna and UnitedHealth Group, which are below their respective national averages.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.