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How to request and bill for ketamine and esketamine
August 21, 2023

This article is for psychiatrists, primary care providers, acute care hospitals, and community mental health centers caring for our members

Intravenous ketamine and intranasal esketamine share the same medical necessity criteria for treatment-resistant depression, found in our medical policy 087. For that reason, you can use an approval for one drug/procedure for either treatment during the approval period without requesting a new prior authorization. Here are some tips to help you request authorization and bill for services:

When you are

Please

Requesting authorizations for either intravenous ketamine or intranasal esketamine
  • Submit code G2082 in Authorization Manager regardless of which drug you will be administering, AND
  • Specify which drug you are requesting in any attached clinical information or on the attached PA request form.

 

Billing for the service
    • Use code J3490 with intravenous infusion codes for intravenous ketamine infusions, or
    • Use code G2082 or G2083 for intranasal esketamine treatments

MPC072023-1F-1-ART