Buying and Billing Spravato: The Nitty Gritty

When it comes to buying and billing for Spravato, understanding the correct coding is essential for ensuring proper reimbursement and compliance. Here's a detailed guide on how to navigate the process.

Coding for Spravato Administration

Spravato (esketamine) requires specific codes for its administration and monitoring. The codes you'll use depend on the dosage and whether you're billing Medicare or a commercial payer.

Medicare Coding

For Medicare, there are two main codes to remember:

• G2082: This code covers the administration, monitoring, and supply of Ketamine 56mg or less.
• G2083: This code is for the administration, monitoring, and supply of Ketamine 84mg.

It's crucial to use these codes exclusively when billing Medicare for Spravato. Using any other coding method is considered unbundling and can lead to complications or denial of claims.

Commercial Payer Coding

Commercial payers may have different requirements. While some might accept the G2083 code, it's important to verify with your specific payer and review your contract. For those payers who allow it, typically commercial ones, the coding is as follows:

• 99215: This code is for the office or other outpatient visits for the evaluation and management of an established patient, which may require detailed history, examination, and medical decision-making.
• G2212/99417: These codes are for prolonged services, reported in units based on the time spent.
• S0013: This code is used for each milligram of Spravato administered.

For example:

• A 56mg dose would be coded as S0013 x 56.
• An 84mg dose would be coded as S0013 x 84.

Key Points to Remember

1. Medicare Billing: Always use G2082 for doses 56mg or less and G2083 for doses 84mg.
2. Commercial Payer Billing: Check with your payer for specific requirements, but typically use 99215, G2212/99417 for prolonged services, and S0013 for the dosage.
3. Verify Contracts: Ensure you are compliant with your payer contracts to avoid denied claims.

Disclaimer

This guide is based on practical experience and is not intended as legal advice. Always consult with a billing expert or legal advisor to ensure compliance with current coding and billing regulations.