Ketalar (Ketamine) and Spravato (Esketamine)

Surest (UnitedHealthcare) · PayerPolicy · SUREST-POL-SUREST-ketalar-spravato

Summary of the payer’s published policy. Not a coverage determination — confirm with Surest (UnitedHealthcare) before submitting.

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Codes in this policy

Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.

Codes this policy lists and each code’s status in the policy
Code	Code system	Status in this policy
J0013	HCPCS	Covered
J3490	HCPCS	Covered