MedicaidBilling CodesMedium impact
Esketamine Billing Instructions
South Dakota Medicaid·SD · Psychiatry·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid is changing the HCPCS code for Esketamine (Spravato) nasal spray billing from S0013 to J0013 effective January 1, 2026. The policy clarifies specific E/M codes and add-on codes for associated professional services and observation time.
Action Required
By January 1, 2026: Billing team must update system to use HCPCS code J0013 instead of S0013 for Esketamine (Spravato) nasal spray for South Dakota Medicaid. Continue using CPT 99205 for new patients, 99215 for established patients, and up to 6 units of 99417 for extended observation time. Ensure prior authorization is obtained before administration.