Use the correct HCPCS code for Spravato®

Use the correct HCPCS code when requesting prior authorization or billing for Spravato (esketamine).

We first communicated about this in the article titled HCPCS replacement codes established, in the March 2021 issue of The Record.

The Centers for Medicare & Medicaid Services, or CMS, established the permanent HCPCS code of S0013 for this medical benefit drug to be used for dates of service on or after Jan. 1, 2021. However, many providers are using the older codes for these newer dates of service. This has resulted in problems with reimbursing claims.

Prior authorization information

Providers must request prior authorization for Spravato when it is administered in outpatient settings for:

Additional information

For more information on requirements related to drugs covered under the medical benefit, see the following documents:

Posted: May 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network