Spravato (Esketamine) Billing Guide

Why Spravato billing needs its own workflow

Spravato (esketamine) nasal spray is self-administered by the patient, but only inside a certified healthcare setting and under direct observation. That mix of a drug, a supervised administration and a monitoring period is why Spravato billing does not fit neatly into ordinary psychiatry coding.

Three questions decide how each session is billed: who the payer is, where the drug came from, and what else the clinician did that day. Answer them once per patient at intake and most claim errors disappear.

This article covers the Medicare G codes, commercial billing patterns, the REMS requirements that affect documentation and the denials practices see most. For related psychiatry codes, see the behavioral health billing guide.

Spravato billing codes G2082 and G2083

CMS created two HCPCS Level II codes for esketamine treatment sessions. Both describe an office or other outpatient visit for an established patient that requires supervision by a physician or other qualified health care professional, provision of esketamine for nasal self-administration and two hours of post-administration observation.

Code	Dose provided	What is bundled
G2082	Up to 56 mg of esketamine	Supervision, the drug provided, and the post-administration observation period
G2083	Greater than 56 mg of esketamine	Supervision, the drug provided, and the post-administration observation period

Pick the code by the dose actually administered at that session, not the planned dose for the course. Labeled doses are commonly 56 mg or 84 mg, so the two codes map to those two dose levels. If the dose changes mid-course, the code changes with it.

Because the codes include the observation time, do not add separate prolonged service or observation codes to a G2082 or G2083 claim. The codes are described for established patients, so the initial psychiatric evaluation that establishes the treatment plan is billed separately on its own date.

How the drug supply path changes the claim

The G codes were designed for settings that supply the drug. In practice, esketamine reaches the clinic in one of two ways, and the billing differs.

Buy-and-bill

The practice purchases Spravato and bills the payer for both the drug and the session. For Medicare Part B, the G codes include the drug, so the practice does not add a separate drug line. Some commercial and Medicaid plans instead ask for the drug on its own line using J0013 (esketamine, nasal spray, 1 mg) with units equal to the milligrams given, plus an administration or visit code. Read each plan's policy before the first claim.

Pharmacy-supplied drug

A specialty pharmacy dispenses the drug under the patient's pharmacy benefit and ships it to the certified site. The practice must not bill for the drug, because the pharmacy already has. Some payers still accept G2082 or G2083 in this situation; others ask for an E/M code, sometimes with clinical staff prolonged service codes for the observation time. This is the area where payer rules differ most, so confirm the expected codes in writing.

Evaluation and management on treatment days

Treatment days often include a medication review, a safety assessment or a change to another prescription. Whether that work can be billed in addition to the session depends on the payer.

• With G2082 or G2083, Medicare treats routine supervision as part of the code. A separate E/M is supportable only when a significant, separately identifiable problem is addressed, documented in its own note and billed with modifier 25.
• Psychotherapy is not part of an esketamine session. If psychotherapy is provided by a prescriber on the same day, it may be billed with an add-on code such as 90833 alongside a properly documented E/M, but time spent on monitoring cannot count toward psychotherapy time.
• When a payer requires an E/M code for the session itself, pick the level based on medical decision making or the practitioner's total time on that date, and do not count clinical staff observation time as practitioner time.

Our article on psychotherapy add-on code 90833 explains the documentation for prescriber psychotherapy in more detail.

REMS requirements that shape documentation

Spravato is available only through a Risk Evaluation and Mitigation Strategy (REMS) program because of the risks of sedation, dissociation, respiratory depression and misuse. The REMS affects billing because payers and auditors expect to see that each session met its conditions.

• The healthcare setting, and the pharmacy that dispenses the drug, must be certified in the REMS program.
• The patient self-administers under the direct observation of a healthcare provider.
• The patient is monitored by a healthcare provider for at least two hours after administration, until the provider judges the patient safe to leave.
• The setting completes the monitoring and reporting steps the REMS requires.

The REMS has been modified since launch, so confirm the current requirements on the program's official site rather than relying on older training material. Record the REMS setting certification on file with your payer enrollment records so a coverage reviewer can see it.

Session notes should include the dose, lot number when the practice supplies the drug, the time of administration, vital signs and monitoring observations during the observation period, the discharge time and the clinician who released the patient.

Prior authorization and coverage criteria

Nearly all commercial and Medicaid plans require prior authorization for esketamine. Criteria commonly include a diagnosis of treatment-resistant depression with documented trials of prior antidepressants, or depressive symptoms with acute suicidal ideation or behavior, along with confirmation that the treating site is REMS certified.

Authorizations often cover an induction phase and then require reauthorization for maintenance with updated rating scale scores. Track the approved number of sessions, the dose approved and the end date. Our prior authorization services page describes how approval tracking works across payers.

Common Spravato denials

Denial	Usual cause	Fix
Duplicate drug payment	Practice billed J0013 for pharmacy-dispensed drug	Bill the drug only when the practice bought it
Wrong dose code	G2082 billed for an 84 mg session	Code from the administered dose recorded in the note
E/M bundled	E/M billed without a separately identifiable service	Bill an E/M only when the note supports it, with modifier 25
No authorization	Maintenance sessions billed after induction approval expired	Request reauthorization before the induction count runs out
Place of service rejected	Session reported from a setting the payer does not allow	Confirm the payer's allowed place of service and the site's REMS status

Billing support for esketamine programs

Fastora's certified coders set up payer-specific rules for G2082, G2083 and pharmacy-supplied sessions and review each claim before submission. See how we support psychiatry practices, or start with a free billing assessment of your recent Spravato claims.

Spravato billing company support for esketamine programs

As a Spravato billing company, we support clinics running esketamine programs for treatment-resistant depression: J-code drug billing for the medication itself, administration and observation coding for the supervised session, and the authorization documentation payers require before treatment starts. Spravato claims fail most often on the authorization and documentation side rather than the coding, so our workflow confirms both before the first administration — not after the first denial. Related: behavioral health billing, psychiatry billing, telehealth billing guide.

Frequently asked questions