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08.01.80d, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
Act
by Feb 10, 2026
Effective date
Dec 29, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.01.80d to 08.01.80e, adding coverage for esketamine (Spravato) nasal spray as monotherapy for treatment-resistant major depressive disorder after inadequate response to two oral antidepressants, while clarifying that ketamine for acute/chronic pain, psychiatric indications beyond the specified MDD criteria, and concurrent ketamine-esketamine use remain non-covered as experimental/investigational.
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What to do
by Feb 10, 2026 · 5 steps
01Billing team must update claim submission systems to recognize G2082 and G2083 as covered codes for esketamine administration with required 2-hour post-administration observation.
02Ensure prior authorization workflows capture the five required clinical criteria: DSM-5TR MDD diagnosis, severe depression per validated scale, documented inadequate response (<25% improvement) to at least two FDA-approved antidepressants from different classes at adequate dosages for ≥6 weeks with ≥80% adherence, and treatment-resistant depression status.
03Update encounter forms and templates to prompt providers for depression scale documentation (BDI-II, MADRS, PHQ-9, or HAM-D scores).
04Configure system to deny claims for ketamine (Ketalar) for pain management, esketamine for psychiatric indications other than specified MDD criteria, and concurrent ketamine-esketamine therapy as experimental/investigational.
05Front desk and authorization staff must verify member age ≥18 years at time of service.
If missed: Failure to verify criteria and obtain proper authorization will result in claim denials.
Codes mentioned
99499G2082G2083F32.0F32.1F32.2F32.4F32.5F32.89F33.0F33.1
Original notice
08.01.80d, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →08.01.80e, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)HighEffective Jan 1, 2026 · PharmacyMA08.137d, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)MediumEffective Dec 29, 2025 · Pharmacy08.01.80e, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)HighEffective Jan 1, 2026 · PharmacyMA08.137e, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)HighEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list