Service
Esketamine Claims Submission & Coding
Coding and billing services for Spravato drug administration and clinic observation time.
Billing for Spravato requires precision in code selection and unit calculation. Claims must account for both the drug itself and the mandatory clinical observation period. Errors in unit calculations or code combinations result in immediate denials.
Our team applies coding standards for esketamine claims. We use the appropriate HCPCS and CPT codes depending on the patient’s insurance type.
Commercial and Medicaid Coding
For commercial insurance and Medicaid, we bill the drug separately from the office visit. We use HCPCS code J0013 (Esketamine, nasal spray, 1 mg). We calculate the correct billing units: 56 units for a 56 mg dose, or 84 units for an 84 mg dose. We pair the drug code with appropriate Evaluation and Management (E/M) codes and prolonged service codes to account for the observation time.
Medicare Bundled Coding
Medicare requires bundled billing. We use HCPCS codes G2082 and G2083. Code G2082 covers an office visit for the administration of esketamine up to 56 mg, including the two-hour observation period. Code G2083 covers the same services for doses greater than 56 mg (the 84 mg dose). We do not bill separate E/M codes or prolonged service codes for Medicare claims.