Spravato Billing and Coding: HCPCS and CPT Codes Guide

Billing for Spravato (esketamine nasal spray) requires clinics to code for both the drug and the mandatory two-hour post-administration observation period. Payer guidelines vary significantly between Medicare and commercial insurance plans. This guide details the active codes and billing practices for Spravato treatments.

Key Billing Codes for Spravato

Drug Code: HCPCS J0013

HCPCS code J0013 (Esketamine, nasal spray, 1 mg) is the active code for billing the drug itself.

Payers transitioned to J0013 on January 1, 2026, replacing the temporary code S0013. You must use J0013 for commercial insurance claims, Medicaid, and buy-and-bill models. Calculate the units billed based on the patient’s dose:

• 56 mg Dose: Bill 56 units of J0013.
• 84 mg Dose: Bill 84 units of J0013.

Medicare Bundled Codes: G2082 and G2083

Medicare does not allow separate billing for the drug and the observation visit. You must use the following bundled G-codes:

• G2082: Office/outpatient visit for the administration of esketamine, up to 56 mg, including the required two-hour observation.
• G2083: Office/outpatient visit for the administration of esketamine, greater than 56 mg (the 84 mg dose), including the required two-hour observation.

Do not bill separate Evaluation and Management (E/M) codes or prolonged service codes alongside G2082 or G2083 for Medicare patients.

Commercial Insurance Coding Structure

Commercial payers typically require a split-billing method where you bill the drug and the administration/observation separately. A standard commercial claim includes:

1. HCPCS Code J0013: For the drug, specifying 56 or 84 units.
2. Office Visit CPT Code (99213 or 99214): For the evaluation and management of the patient.
3. Prolonged Services Codes (99417 or G2212): To account for the mandatory two-hour observation period. Payers require documentation of the exact start and stop times of the face-to-face monitoring.

Mandatory Documentation for REMS Compliance

Payers audit Spravato claims to confirm compliance with the SPRAVATO REMS program. To protect claims against recoupment during post-payment audits, treatment records must document:

• The clinical supervision of the patient during the entire two-hour observation period.
• The name of the supervising healthcare provider.
• Blood pressure measurements recorded at baseline, at the one-hour mark, and at the two-hour mark.
• The exact times the observation period started and finished.