Billing Guidance for Spravato® Nasal Spray

Thursday, November 18, 2021

Spravato (esketamine) nasal spray is a limited benefit under TRICARE for beneficiaries ages 18 and older who have been diagnosed with treatment-resistant depression. Health Net Federal Services, LLC has noticed an increase in providers submitting claims for Spravato that include evaluation and management (E/M) codes instead of the appropriate G codes. We offer the following reminders to help prevent claims being denied or rejected.

TRICARE follows the Centers for Medicare & Medicaid (CMS) billing guidelines for Spravato, which specify use of CPT® codes G2082-G2083 rather than E/M codes. Per the American Medical Association, both G2082 and G2083 encompass administration of the drug and post-administration observation services. We recognize some providers may also include HCPCS code J3490 with a nominal charge (e.g., $0.01) on a claim for administrative purposes. This is an acceptable practice that will not impact claims processing.

As a reminder, prior 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.

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