Back to dashboard
MedicaidPrior AuthMedium impact

Spravato Coverage Guidelines pdf

Connecticut Medicaid (HUSKY Health)·CT · Psychiatry·Provider Bulletin
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid (HUSKY A/B/C/D) is implementing prior authorization requirements for Spravato (esketamine) nasal spray effective January 1, 2021. New billing codes G2082 and G2083 for outpatient hospitals and S0013 for physician offices are introduced with specific administration and monitoring requirements.

Action Required

Action needed
By January 1, 2021: Billing team must update system to require prior authorization for all Spravato claims using new PA forms from ctdssmap.com. Outpatient hospitals must use G2082/G2083 codes with RCC 919 and submit PA requests to CT BHP at 1-866-434-7681. Physician offices must use S0013 code (replaces J3490) with appropriate E&M codes. Authorization is limited to 6 months and requires re-authorization.

Affected Billing Codes

G2082
G2083
S0013
J3490
99202
99203
99204
99205
99212
99213
99214
99215