Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)
Effective date
Not stated in the notice
Identified
Aug 16, 2026
Summary
Aetna considers ketamine experimental, investigational, or unproven when given intramuscularly, intranasally, intravenously, orally, or subcutaneously for acute pain, central body pain, chronic pain, neuropathic pain, depression, generalized anxiety and social anxiety disorders, post-traumatic stress disorder, alcohol and substance use disorders, suicidal ideation, post-concussion syndrome, sickle cell vaso-occlusive crises, depression-associated sleep disturbances, stress-induced maladaptive behavior, and as a diagnostic test for catatonia. Ketamine-assisted therapy for the treatment of depression is also considered experimental, investigational, or unproven. The policy lists ICD-10 codes for these indications as not covered and states that no specific HCPCS code exists for ketamine or ketamine-assisted therapy.
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01Billing team: Do not expect coverage for ketamine or ketamine-assisted therapy when billed for the indications listed in this policy, because they are considered experimental, investigational, or unproven.
02The listed ICD-10 codes are not covered for these indications, including F32.0 through F33.9 (major depressive disorders), F43.10 through F43.12 (post-traumatic stress disorder), G89.29 (other chronic pain), and R52 (pain, unspecified).
03The related IV infusion administration codes are 96365 through 96368 and 96372.
04Esketamine (Spravato) is addressed in related policy CPB 0950.
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