Find policies, billing codes, payers, states, and providers
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders
Customize your policy alerts
Sign up for Premera Bluecross Policy 5.01.586 alerts
Get alerted when Policy 5.01.586 changes without checking for updates manually.
Monitor payer policy activity
Defines coverage stance for intravenous infusion of anesthetic agents (including ketamine and lidocaine) for chronic pain syndromes and psychiatric/substance use disorders, and describes associated coding and evidence considerations for providers.
IV ketamine is considered investigational in any setting or in conjunction with any other service, not just when it is either monotherapy or in conjunction with psychotherapy.
In addition to IV ketamine, any office visits, clinic visits, psychotherapy sessions, evaluation and management sessions, or any other sessions during which IV ketamine is administered are also considered investigational.
HCPCS code J2001 was removed from the policy (termed October 1, 2024).
Coverage Criteria and Rationale
Investigational — Intravenous anesthetic infusions
Covered when ALL of the following are met
Services are categorized as investigational irrespective of setting or concurrent services.
Related encounters during administration inherit investigational status.
Applies to lidocaine and other IV anesthetics for listed chronic pain conditions.
Coverage rationale (Investigational / insufficient evidence)
Policy stance and evidence summary informing coverage:
From policy history clarifications
From summary of evidence
From regulatory status
This policy does not address continuous subcutaneous or IV infusion of anesthetics for managing chronic pain conditions such as terminal cancer pain. The document distinguishes episodic subanesthetic IV courses (e.g., test infusions or short courses of lidocaine or ketamine used in treatment planning or research for chronic neuropathic pain) from continuous infusions intended for long‑term symptom control, which are outside the scope of this policy. (See definitions of chronic daily headache, neuropathic pain, and related clinical context.)
This policy does not apply to Medicare Advantage determinations and notes that IV ketamine and IV lidocaine for chronic pain or psychiatric disorders are off‑label uses per FDA approvals. The policy further clarifies operational and coverage implications in its history and regulatory sections, including changes to investigational designations and code listings. Providers should verify member benefit plan limits and prior‑authorization requirements with the member’s plan.
The available evidence is insufficient to conclude that IV anesthetic infusions (including ketamine and lidocaine) for chronic pain syndromes or treatment‑resistant psychiatric disorders improve net health outcomes. Randomized trials and systematic reviews report short‑term symptom improvements in some settings (for example, temporary relief for some chronic pain patients or transient depression benefit lasting days to a few weeks), but limitations such as small sample sizes, lack of active controls, possible unblinding, carryover effects, short durability of benefit, and treatment‑related adverse events raise concerns about net benefit. Additional well‑designed clinical trials evaluating long‑term efficacy and safety are needed.
The policy explicitly states that IV ketamine in any setting or in conjunction with any other service is considered investigational. This designation was clarified to apply regardless of whether ketamine is provided as monotherapy, as part of ketamine‑assisted psychotherapy, or during any office, clinic, psychotherapy, evaluation and management, or other session in which IV ketamine is administered; such services are therefore subject to investigational exclusion and may be denied.
Billing and Code Lists
| 0820T | Continuous in-person monitoring and intervention (e.g., psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; first physician or other qualified health care professional, each hour. |
| 0821T | Continuous in-person monitoring and intervention (e.g., psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; second physician or other qualified health care professional, concurrent with first physician or other qualified health care professional, each hour (List separately in addition to code for primary procedure). |
| 0822T | Continuous in-person monitoring and intervention (e.g., psychotherapy, crisis intervention), as needed, during psychedelic medication therapy; clinical staff under |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour. |
| 96366 | Each additional hour (list separately in addition to code for primary procedure). |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug. |
| J3490 | Unclassified drugs. |
| J2001 | Removed/termed October 1, 2024 |
Provider Billing, Authorization, and Documentation
Billing codes for IV anesthetic infusion services
Use the listed CPT and HCPCS codes when billing for IV anesthetic infusion services and related continuous monitoring/psychotherapy: 0820T, 0821T, 0822T, 96365, 96366, 96374, and J3490 (unclassified drugs). Note that HCPCS code J2001 was removed (termed Oct 1, 2024).
- 0820T — Continuous in‑person monitoring/intervention, first physician/qualified health professional, per hour.
- 0821T — Continuous in‑person monitoring/intervention, second physician/qualified health professional (concurrent), per hour.
- 0822T — Continuous in‑person monitoring/intervention, clinical staff (description truncated in source).
- 96365 — Intravenous infusion, initial, up to 1 hour.
- 96366 — Each additional hour (list separately).
- 96374 — Therapeutic/prophylactic/diagnostic injection; IV push, single or initial substance/drug.
- J3490 — Unclassified drugs.
- J2001 — Previously listed HCPCS code removed (termed October 1, 2024).
Confirm benefits and prior authorization requirements
Verify member benefits and prior authorization requirements before scheduling IV anesthetic infusion services; coverage determinations are subject to the limits and conditions of the member's benefit plan and may require prior authorization per the plan.
- Consult the member benefit booklet or contact member services to determine applicable benefit limitations.
- Prior authorization may be required by the member's plan (policy does not specify plan-level PA rules).
Step‑therapy context — informational
This policy describes typical clinical treatment pathways (e.g., fibromyalgia treatments such as pregabalin, non‑narcotic analgesics, or low‑dose antidepressants) and states that IV anesthetic infusions are considered an investigational approach rather than an established step in therapy; no formal step‑therapy algorithm or mandatory sequencing is specified.
- Fibromyalgia is typically treated with neuropathic pain medications such as pregabalin, non‑narcotic pain relievers, or low doses of antidepressants.
- The policy does not establish a required step‑therapy pathway for IV anesthetic infusions.
Coding and documentation guidance for billing
Include documentation of the IV infusion and associated monitoring or psychotherapy services and bill using the appropriate CPT/HCPCS codes listed in the policy; however, the policy classifies these uses as investigational and not supported for the covered indications.
Benefit verification required
Before providing services, verify that the member’s plan covers the service and any limitations; consult the member benefit booklet or contact customer service to determine coverage for a specific member.
- Coverage is subject to the limits and conditions of the member benefit plan.
- Contact member services or review the benefit booklet to confirm coverage and prior authorization requirements.
Services considered investigational — potential grounds for denial
IV infusion of ketamine (for depression, anxiety, other psychiatric disorders, substance use disorders, and/or chronic pain) and IV infusion of other anesthetics (e.g., lidocaine) for chronic pain are designated investigational and therefore are subject to denial.
- Investigational status applies irrespective of setting or whether administered in conjunction with other services (includes ketamine‑assisted psychotherapy).
- Related office visits, clinic visits, psychotherapy sessions, evaluation and management sessions, or any sessions during which IV ketamine is administered are also considered investigational.
Investigational designation creates denial risk for IV ketamine services
Because the policy designates IV ketamine (and associated sessions during which IV ketamine is administered) as investigational in any setting, submitting claims or requests for authorization for these services creates a denial risk under this policy.
- The July 1, 2026 policy clarification explicitly states IV ketamine is investigational in any setting or in conjunction with any other service.
- Operational clarification: related encounters during administration inherit investigational status and may be denied.
Background and Evidence Summary
Intravenous ketamine and lidocaine have been studied for chronic neuropathic pain, chronic daily headache, fibromyalgia, and treatment‑resistant psychiatric disorders (including major depressive disorder, OCD, and PTSD). Protocols commonly involve subanesthetic infusions delivered over hours, sometimes as a series of repeated infusions. Trials report transient symptom improvements in some patients but are limited by small sample sizes, inconsistent controls, short durability of effect, and a risk of adverse events such as headache, anxiety, dissociation, nausea, and dizziness. Regulatory status notes that IV ketamine and IV lidocaine for these indications are off‑label. Given these factors, the policy classifies IV lidocaine and IV ketamine infusions for the listed chronic pain and psychiatric/substance use disorder indications as investigational.
Clinical Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.