May 1, 2023
SPRAVATO™ (esketamine) nasal spray, CIII
Intranasal esketamine is FDA approved for treatment-resistant depression in adults. It is only available through a Risk Evaluation and Mitigation Strategy program (REMS) because of the risks of serious adverse outcomes from sedation, dissociation, and abuse and misuse. The healthcare setting must be enrolled in the program and comply with the program requirements. Requirements of the program include that Spravato is only dispensed in healthcare settings and administered to patients enrolled in the REMS program. The medication is administered by patients under the direct observation of a healthcare provider and are monitored for at least two hours after administration. Additionally, pharmacies must be certified in the REMS and only dispense SPRAVATO to healthcare settings that are certified in the program.
Further information, including a list of certified pharmacies is available at www.SPRAVATOrems.com or 1-855-382-6022.
To bill claims for Spravato use:
- G2082 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation
OR
- G2083 Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation
- Do not add miscellaneous drug code (J-codes) as the above codes include the drug.
- Append KX modifier to identify enrollment in the FDA REMS program.
- For electronic claims enter the facility and zip code in the notepad.
- For paper claims enter the facility and zip code in the block 19.
- If the healthcare system is not enrolled in the REMS program the claim is subject to denial.