CommercialCoverageHigh impact
Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)
Aetna·Psychiatry, Pain Management, Internal Medicine +2 more·Medical Policy
Effective date
Dec 30, 2025
We identified it
Aug 16, 2026
Summary
Aetna (CPB 0938, effective 2025-12-30) classifies ketamine for depression, pain, PTSD, anxiety, substance use disorders, and multiple other indications as experimental, investigational, or unproven. Ketamine-assisted therapy for depression is also not covered. Billing teams must deny all claims for ketamine administration and ketamine-assisted therapy submitted under these diagnoses and update denial protocols immediately.
Action Required
By 2025-12-30: Billing team must immediately update claim adjudication system to deny all ketamine and ketamine-assisted therapy claims when billed with ICD-10 codes F32.0-F33.9 (major depressive disorder), F41.1 (generalized anxiety disorder), F40.10-F40.11 (social phobia), F43.10-F43.12 (PTSD), F10.10-F19.99 (substance-related disorders), D57.819 (sickle cell crisis), G89.0-G89.29 (pain syndromes), F06.1 (catatonia), F07.81 (post-concussion), R45.851 (suicidal ideation), F51.01-F51.9 (sleep disorders), or other listed diagnoses. Update CPT codes 96365-96368 (IV infusion) and 96372 (injection) to automatically flag and deny when linked to ketamine administration. Notify providers and front desk staff that ketamine treatment for these conditions is not covered under Aetna plans effective immediately. Update denial letter templates to reference CPB 0938. Flag all pending claims for manual review and denial. Consequences: Failure to implement these denials will result in payment of non-covered services and subsequent recoupment attempts from the practice.