CommercialBilling CodesMedium impact
Spravato (esketamine)
Blue Cross & Blue Shield of Mississippi·MS · Psychiatry, Internal Medicine, Family Medicine·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Spravato (esketamine) policy, maintaining that the drug is not medically necessary for treatment-resistant depression and major depressive disorder due to other available alternatives. The policy also updated the HCPCS code from S0013 to J0013 effective January 1, 2026.
Action Required
Immediately: Billing team must update system to use new HCPCS code J0013 instead of deleted code S0013 for esketamine nasal spray billing. Verify prior authorization is obtained through BCBSMS PA review process before administering Spravato, as services without approved PA will be considered not medically necessary and claims will be denied. For State Health Plan members, submit PA requests to CVS Caremark pharmacy benefit manager.