Spravato Billing Services
Spravato Billing Services For Psychiatry Practices
We bill Spravato for psychiatry practices, and the first question decides the claim. Does this payer want J0013 units, or Medicare’s bundled G2082 and G2083? Every dose also ties up a monitored room for at least two hours, and the claim can still fail on the unit count, an expired authorization or a missing observation note. We set the billing up so that doesn’t happen, then keep working those claims every month.
The Codes
Which Code Goes On The Claim Depends On Who’s Paying
Spravato doesn’t have one billing code. When the practice buys the drug, Medicare pays for the whole session through one bundled G-code. Medicaid and most commercial plans want the drug reported as J0013 units, usually next to a separate visit code. Bill the wrong model and the claim comes back, even when everything clinical went right.
| Code | What It Reports | Who Usually Uses It |
|---|---|---|
| G2082 | An established patient visit, up to 56 mg of esketamine and two hours of post-administration observation, as one line | Medicare, when the practice bought the drug. Some other plans accept it too |
| G2083 | The same bundle for doses over 56 mg | Medicare, same conditions |
| J0013 | Esketamine, nasal spray, 1 mg. One unit per milligram, so an 84 mg session is 84 units | Medicaid and most commercial plans, with the visit codes the payer allows. Medicare doesn’t pay it |
| S0013 | Retired as of January 1, 2026, when J0013 replaced it | No one. A current claim shouldn’t carry it |
Two details catch people. During the switch to J0013, some payers may still ask for J3490, the unclassified drug code. And Medicare Advantage plans can choose a different benefit design, so we don’t assume they follow Medicare. We check each one like a commercial plan. We confirm every payer’s model and write it into your billing notes before the first induction claim goes out. The coding detail lives in our Spravato billing guide.
REMS And The Schedule
Two Hours Per Dose Sets Your Capacity
Spravato is only available through the SPRAVATO REMS. Every dose has to be given in a certified healthcare setting, and the patient has to be monitored by a healthcare provider for at least two hours afterward. That monitoring time is part of what the G-codes pay for. It’s also what the chart has to show when a payer asks.
The label schedule front-loads the work: twice a week in weeks 1 to 4, once a week in weeks 5 to 8, then weekly or every two weeks after that. So a new patient uses eight sessions in the first month. Your prescriber sets each patient’s schedule. We plan the rooms and the authorizations around it.
We plan capacity with one rule of thumb. Sessions per day roughly equals monitored rooms times staffed hours, divided by about 2.5. Three rooms staffed for 10 hours gives you about 12 sessions a day, and if you fill all 12 with maintenance patients, there’s nowhere to start anyone new. Starting a Spravato program walks through the rest of the launch math.
Where Claims Fail
Four Places Spravato Claims Break
Buy-And-Bill Vs. Specialty Pharmacy
Under buy-and-bill, the practice buys the drug from an authorized distributor and bills it. When a REMS-certified specialty pharmacy supplies it instead, Janssen’s coding guide says the practice can’t report G2082 or G2083, even for Medicare, and bills its own services. Plenty of programs run both paths, so it’s checked patient by patient.
Units That Don’t Match The Dose
J0013 counts milligrams, so 56 mg is 56 units and 84 mg is 84. On Medicare, 56 mg is the line between G2082 and G2083. The dose in that day’s note decides both the unit count and the code, and if the claim doesn’t match the note, it comes back for rework.
Authorization For The Drug
Spravato almost always needs a prior authorization on top of REMS enrollment. The costly miss is a reauthorization that lapses between induction and maintenance while the patient keeps coming in. Our prior authorization playbook covers the windows.
Observation Documentation
The two-hour monitoring window has to be in the record. Undocumented monitoring time, or a REMS site the payer doesn’t have on file, turns into a denial you could have prevented.
What We Do
Fix The Setup, Then Keep The Claims Moving
Automation Programs For Specialty Programs
When the setup is what’s breaking, an Automation Program builds one workflow from start to finish in your own systems for $5,000, or 5 monthly payments of $1,000. On a Spravato, TMS or ketamine program, that’s usually room scheduling by observation time, authorization and REMS tracking, reminders or reporting. You get the tracker your team works from, the automations behind it, one dashboard, a staff walkthrough and 30 days of fixes after go-live. Bigger builds that cover several workflows get priced in writing first. REMS certification and every patient care decision stay with your clinical team.
Ongoing Billing For The Claims
Ongoing Billing is priced by practice size, from 7% of collections for a solo provider down to 4.5% for 26 or more providers, with no setup fee. The monthly minimum is $300 for a solo practice. It covers claim scrubbing and submission, rejection and denial follow-up, payment posting and adjustments, A/R follow-up, reconciliation and reporting. Eligibility and benefits verification and prior authorization need a separate written scope, and on a Spravato program that’s work you’ll want someone to own. See billing prices by practice size.
Ryan Berg has spent sixteen years inside behavioral health revenue cycle and credentialing, and he leads this work himself. To see what it looks like on a working program, read the Spravato scheduling case study: authorization dates and remaining room time on one screen, built on the reports the team already had.
Plain-Language Answers
Spravato Billing Questions
What Do Your Spravato Billing Services Cost?
Ongoing Billing is priced by practice size, from 7% of collections for a solo provider down to 4.5% for 26 or more providers, with no setup fee. If the program’s setup needs work first, an Automation Program builds one workflow, such as room scheduling or authorization tracking, for $5,000. Eligibility checks and prior authorization aren’t included unless a separate written scope adds them.
Do You Bill Spravato Under J0013 Or The G-Codes?
It depends on who’s paying. When your practice bought the drug, Medicare uses G2082 for sessions up to 56 mg and G2083 for sessions over 56 mg, and each one bundles the visit, the drug and the two-hour observation. Medicaid and most commercial plans want J0013, billed per 1 mg unit, usually with a separate visit code. We confirm each payer’s model before the first claim.
Can We Bill G2082 Or G2083 If A Specialty Pharmacy Supplied The Drug?
No. Janssen’s coding guide says the bundled G-codes can only be billed when the office bought the drug through a specialty distributor. When a specialty pharmacy supplies it, the practice bills its own services and leaves the drug off its claim.
Can We Still Bill S0013?
No. CMS discontinued S0013 as of January 1, 2026 and replaced it with J0013. During the transition some payers may still ask for J3490, the unclassified drug code, so check each payer’s current policy before you bill.
Do You Handle REMS Certification Or Prior Authorizations?
We don’t handle REMS certification, and your clinical team keeps every patient care and REMS decision. Prior authorization isn’t part of Ongoing Billing unless a separate written scope adds it. An Automation Program can build your authorization and REMS tracking, so an expiring authorization shows up as an assigned task before the next scheduled session.
Before The Next Induction Claim
Get Your Spravato Billing Set Up Right.
We confirm each payer’s billing model, match the units to the dose in the note, and keep the observation time on the record before the claim goes out. Then we work those claims every month.