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Texas Medicaid Prior Authorization Update for Esketamine (Spravato) Effective October 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after October 1, 2025, Texas Medicaid will include diagnosis code F323 in the list of criteria considered for prior authorization requests for esketamine (Spravato) (procedure code S0013).

Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.48.1, “Prior Authorization,” for a list of additional diagnosis codes that Texas Medicaid will consider for prior authorization.

For more information, call the TMHP Contact Center at 800-925-9126.