MedicaidPrior AuthMedium impact
BT2024144: PA criteria added for Spravato (esketamine) visit codes G2082 and G2083; billing rules to be enforced
Indiana Medicaid (IHCP)·IN · Psychiatry·Claims & Billing
Effective date
Oct 17, 2024
We identified it
Jun 19, 2026
Summary
Effective October 17, 2024, Indiana Medicaid will require prior authorization for Spravato (esketamine) visit codes G2082 and G2083, with the same criteria as S0013 (patient must be 18+ and taking oral antidepressant). The policy also enforces existing billing rules prohibiting simultaneous billing of G2082/G2083 with S0013 or E/M codes.
Action Required
By October 17, 2024: Billing team must update system to require prior authorization for codes G2082 and G2083, ensuring patients are 18+ and taking oral antidepressants. Immediately: Update billing edits to prevent submission of G2082/G2083 with S0013 or E/M codes on same date of service, as these will be denied as medically unnecessary.