J0013: Esketamine, nasal spray, 1 mg
J0013 is a HCPCS Level II code for esketamine, nasal spray, 1 mg. It belongs to the Drugs Administered Other Than Oral Method section. Medicare does not pay it: see the coverage note below before you bill it.
Medicare coverage: Not payable by Medicare
Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusN
Non-covered service. Medicare does not cover it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits: units per day
The most units of J0013 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 84 units MAI 3: Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 84 units MAI 3: Date of Service Edit: Clinical · Prescribing Information
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute, no documentation overrides it. CMS MUE 2026Q4.
The CMS record for J0013
- Long descriptor
- Esketamine, nasal spray, 1 mg
- Short descriptor
- Esketamine, nasal spray
- Added
- January 1, 2026
- BETOS
- O1E
- Pricing indicator
- 00: Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service: CMS's own analytic grouping.
Service not separately priced by Part B, not covered, bundled into another service, or used by Part A only.
Codes adjacent to J0013
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If J0013 is not quite right, the correct code is very often within a few positions of it.
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