Spravato (Esketamine) is a breakthrough for treatment-resistant depression, but it's a "buy-and-bill" drug. This means your practice buys the drug upfront and bills for the drug and the monitoring. This is a complex RCM process with high financial risk if done incorrectly.
The Spravato Billing Codes
J-Code (The Drug):
- Bill J3490 (Unclassified drug) or S0013 (Esketamine) depending on the payer. This is how you get reimbursed for the cost of the drug.
G-Codes (The Monitoring):
- G2082: Office-based esketamine; monitoring for up to 2 hours.
- G2083: Office-based esketamine; monitoring for more than 2 hours.
Buy-and-Bill & REMS
- REMS Program: Your practice and patient must be enrolled in the Spravato REMS program. This is a non-negotiable requirement.
- Buy-and-Bill: You purchase the drug. You must have a rock-solid benefits verification and prior auth process, or you will own a very expensive drug you won't be paid for.
- Monitoring: The G-codes cover the mandatory 2-hour post-dose observation required by the REMS program.
E/M Visit on the Same Day?
"Do not bill an E/M (9921x) on the same day as the G-code unless you perform a significant, separately identifiable E/M service. The pre- and post-dose assessment is bundled into G2082/G2083."
