Specialized Revenue Cycle Management
Spravato Billing Services
Dedicated medical billing, prior authorization management, and REMS compliance auditing for healthcare providers administering esketamine.
Services Workflow
Administrative support for esketamine treatments
We manage prior authorizations, billing codes, and compliance documentation.
- 100%
- Spravato Focus
- 98%+
- Clean Claim Rate
- 2 Hour
- Observation Audited
Revenue Optimization
Comprehensive Esketamine Revenue Cycle Management
Professional billing services configured to navigate the complex compliance requirements of esketamine nasal spray.
Commercial Insurance & Buy-and-Bill Workflows
We configure claims for commercial plans using the buy-and-bill or specialty pharmacy models, ensuring the esketamine drug and clinic observation time are billed with appropriate coding structures.
Medicare Bundled Billing Compliance
We manage the unique bundled coding structure mandated by Medicare, consolidating the esketamine drug and two-hour observation period into a single clean claim.
Managed Medicaid & State-Specific Rules
We track and apply state-specific Medicaid guidelines and authorization rules, preventing denials related to regional program variations and observation restrictions.
CPT & HCPCS Coding
Essential Coding Standards for Spravato Administration
Correct code selection and unit calculation are critical to prevent claims rejections and audits.
HCPCS Code J0013 Unit Calculations
Claims require accurate calculations based on the administered dose: 56 units of J0013 for the 56 mg dose, and 84 units for the 84 mg dose. We verify that these units are logged correctly prior to submission.
Bundled G-Codes (G2082 & G2083) for Medicare
Medicare claims must use G2082 (for 56 mg) and G2083 (for 84 mg) to bundle the drug and observation. Separate E/M billing is prohibited under these codes.
Prolonged Service CPT Codes for Commercial Claims
Commercial billing splits the claim, requiring an E/M code paired with prolonged service codes (such as CPT 99417 or G2212) to account for the mandatory two-hour monitoring period.
Compliance Auditing
Prior Authorization & Clinical Necessity Documentation
We ensure clinical necessity guidelines are documented to protect your practice against post-payment recoupment audits.
Documenting Treatment-Resistant Depression (TRD)
Payer guidelines require clear clinical documentation confirming the patient meets the criteria for TRD within the current depressive episode.
Pre-screening Antidepressant Trial History
We verify that at least two prior oral antidepressant trials of adequate dose and duration are fully documented in the patient’s history to satisfy prior authorization rules.
REMS Program Log Audit Protection
We audit clinical charts to verify that REMS log entries (including baseline, one-hour, and two-hour blood pressure readings) are complete and match the claim observation times.
Frequently asked questions
How is the Spravato drug billed for commercial insurance?
For commercial plans, we bill esketamine using HCPCS code J0013. We calculate the units based on the dosage administered: 56 units for a 56 mg dose, or 84 units for an 84 mg dose.
What codes are used for Medicare Spravato claims?
Medicare claims require bundled billing. We use G2082 for a 56 mg dose and G2083 for an 84 mg dose. These codes include the drug, administration, and the required two-hour observation period.
Why are Spravato claims frequently denied?
Claims are often denied due to prior authorization omissions, missing documentation of the two-hour observation period, or incorrect unit billing of code J0013.
What is the prior authorization criteria for treatment-resistant depression?
Payers typically require documented clinical evidence that the patient has failed at least two different oral antidepressants of adequate dose and duration in the current major depressive episode.
Audit your billing
Secure your Spravato billing revenue
Contact our billing specialists to review your prior authorization workflows and claims documentation.