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08.01.80e, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
Effective date
Jan 1, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 08.01.80e effective 01/01/2026 with a critical billing code change: HCPCS code J0013 (Esketamine nasal spray, 1 mg) replaces the deleted code S0013 for intranasal esketamine (Spravato) claims. Billing teams must immediately update systems to use J0013 for all esketamine nasal spray billing to avoid claim denials. The policy maintains coverage criteria for intravenous ketamine and intranasal esketamine for treatment-resistant depression and other specified indications.
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What to do
Action · 6 steps
01By 01/01/2026: Billing team must update all billing software, claims templates, and superbill systems to replace deleted HCPCS code S0013 with new code J0013 for esketamine nasal spray (Spravato) billing.
02Audit any pending or in-process claims using S0013 and resubmit with J0013 to prevent denials.
03Verify that claims processing rules reflect the code change in the system.
04Notify providers and clinical staff that S0013 is no longer valid effective 01/01/2026.
05Confirm that G2082 and G2083 codes for esketamine administration with physician supervision and post-administration observation remain active and correctly mapped.
06Update coding references and internal documentation.
If missed: Failure to implement this change will result in claim denials for all esketamine nasal spray claims submitted on or after the effective date.
Codes mentioned
J0013S0013G2082G208399499F32.0F32.1F32.2F32.4F32.5F32.89F33.0F33.1
Original notice
08.01.80e, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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