CommercialCoverageHigh impact
State and School Employees' Health Insurance Plan - Spravato (esketamine)
Blue Cross & Blue Shield of Mississippi·MS · Psychiatry, Internal Medicine, Family Medicine·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jul 17, 2026
Summary
Effective January 1, 2026, the State and School Employees' Health Insurance Plan (Mississippi) now classifies Spravato (esketamine) as not medically necessary for treatment-resistant depression and major depressive disorder, citing available alternative treatments. All administration and delivery services related to Spravato are also deemed not medically necessary. The drug is considered investigational for all other conditions.
Action Required
By January 1, 2026: Billing team must immediately update billing system to deny all claims for Spravato (esketamine) administration and drug codes (G2082, G2083, J0013, J3490) for this plan. Update encounter forms and templates to block providers from ordering Spravato for TRD and MDD patients. Implement automated claim edits to reject these codes at submission. Train front desk and billing staff to inform patients that Spravato is not covered and alternative treatments should be discussed with providers. Notify prescribing physicians in your practice of the non-coverage determination. Failed compliance will result in claim denials and potential revenue loss. Flag any pending Spravato claims for this plan for immediate review and resubmission denial before the effective date.