08.01.80d, Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)

By 12/29/2025: Billing and clinical teams must review the full policy text at the provided URL to identify specific medical necessity criteria, prior authorization requirements, and documentation standards for ketamine/esketamine claims. Update billing system rules, prior auth workflows, and provider encounter documentation templates accordingly. Ensure all claims submitted after the effective date include required medical necessity documentation. Contact the payer (IBX) for specific billing codes and authorization procedures if not detailed in the full policy. Claims submitted without meeting the new medical necessity criteria may be denied.