Billing Guidance for Spravato® Nasal Spray

Spravato® (esketamine) nasal spray is a limited benefit under TRICARE for beneficiaries ages 18 and older who have been diagnosed with treatment-resistant depression.

Pre-authorization is required for all beneficiaries. When requesting approval for Spravato, we strongly encourage prescribing providers to attach our Letter of Attestation (LOA) in lieu of clinical documentation to the authorization request. This will help expedite the review process and ensure all clinical requirements have been met.

For additional benefit details, please review our Spravato Nasal Spray benefits page.

TRICARE follows the Centers for Medicare & Medicaid Services (CMS) billing guidelines for Spravato, which specify use of HCPCS codes G2082-G2083 rather than E/M codes. Per the American Medical Association, both HCPCS codes G2082 and G2083 encompass administration of the drug and post-administration observation services. Providers may not bill solely for Spravato (HCPCS code S0013), as payment for the drug is included in G2082 and G2083 reimbursement.

We recognize some providers also may include HCPCS code J3490 with a nominal charge ($0.01) on a claim for administrative purposes. Per TRICARE policy, Health Net Federal Services, LLC (HNFS) may not reimburse for HCPCS code J3490 on Spravato claims, as providers are to buy-and-bill under HCPCS codes G2082 or G2083 only.

Note: HNFS will only reimburse claims submitted by providers who have administered the drug. We will not accept Spravato claims submitted by pharmacy providers.

For more information on CMS billing guidelines, refer to p. 12 of the Spravato “Access & Reimbursement Guide” at www.spravatohcp.com/resources#Janssen_CarePath.