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AetnaCommercial · Prior Auth · Medical Policy · PsychiatryMedium impact

Esketamine (Spravato) (CPB 0950, reviewed 2026-02-25)

Effective date
Not stated in the notice
Identified
Aug 13, 2026

Summary

Aetna's Clinical Policy Bulletin 0950 covers esketamine (Spravato) nasal spray for commercial plans when the member meets its criteria, and precertification is required for all Aetna participating providers and members in applicable plan designs. For treatment-resistant depression, the member must be 18 or older with a severe major depressive disorder confirmed by a standardized rating scale, and must have had an inadequate response to two antidepressants from two different classes, each used for at least 8 weeks within the past 5 years, plus augmentation therapy or evidence-based psychotherapy during the current depressive episode. The medication must be prescribed by or in consultation with a psychiatrist and given under the direct supervision of a healthcare provider, with the member monitored for at least 2 hours after administration.

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What to do

Action · 9 steps
01Before starting esketamine: Get precertification by calling (866) 752-7021 or faxing (888) 267-3277, and use the Statement of Medical Necessity forms under Specialty Pharmacy Precertification where applicable.
02Providers: Document a confirmed severe major depressive disorder diagnosis using a standardized rating scale such as the BDI, HDRS or MADRS, and document that the member is 18 or older.
03Confirm the member does not have moderate or severe substance or alcohol use disorder unless the member is currently receiving treatment or medical management.
04Document the required two-antidepressant history with dates and doses, and the augmentation or psychotherapy history.
05Keep the 2-hour post-dose monitoring and direct supervision documented for each session.
06Continuation for treatment-resistant depression is covered for 6 months when there is improvement or sustained improvement from baseline on a standardized rating scale.
07For major depressive disorder with acute suicidal ideation or behavior, continuation is covered for up to 4 weeks total.
08Billing team: Bill HCPCS G2082 for up to 56 mg or G2083 for more than 56 mg with the supervised office visit, J0013 per 1 mg of esketamine, and T1503 for administration, when the criteria are met.
09Use ICD-10 codes F32.0 to F32.A, F33.0 to F33.9, or R45.851 as the source lists them.

Codes mentioned

G2082G2083J0013T1503F32.0F32.AF33.0F33.9R45.851

Original notice

Esketamine (Spravato) (CPB 0950, reviewed 2026-02-25)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesPsychiatryCode G2082Code G2083Code J0013Code T1503Code F32.0Code F32.ACode F33.0Code F33.9Code R45.851

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