Every Spravato session approved, documented, and paid. Spravato therapy billing for clinics that can't afford a denied treatment.
Nevada Medical Billing provides Spravato billing services for psychiatric practices, PMHNP clinics, and interventional mental health centers across Nevada. We handle the parts of esketamine treatment that decide whether you get paid: benefit checks, prior authorizations and reauthorizations, the right codes for each payer, drug billing under buy-and-bill or specialty pharmacy, observation-time documentation, and denial appeals. We bill Medicare, Medicare Advantage, Nevada Medicaid and its five managed care plans, and commercial insurers.
Share a few details and a Spravato billing specialist will review your authorizations, codes, and drug reimbursement with you.
Spravato billing is different because one session combines a controlled drug, a supervised self-administration, and at least two hours of monitoring, and payers code those pieces differently. Medicare bundles the visit, observation, and drug into one G-code. Commercial plans and many Medicaid plans usually want the drug billed separately in milligrams and the visit billed on its own. Get the model wrong and the claim is denied, underpaid, or paid for the visit but not the drug.
On top of that, Spravato is a high-cost drug delivered twice a week during induction. One expired authorization or one month of unbilled drug can cost a clinic more than a year of routine follow-up visits.
CMS deleted S0013 on December 31, 2025, and replaced it with J0013. Claims still using S0013 are rejected, and authorizations issued under S0013 often have to be updated to J0013 by the payer. That update isn't automatic.
J0013 is billed per milligram, so an 84 mg session is 84 units. Billing one unit per device, or per session, underpays the drug on every claim.
G2082 and G2083 already include the visit and observation. Adding a separate E/M for the same encounter triggers a denial or a recoupment later.
Induction, maintenance, and continuation are often approved separately, with different session counts. When the induction approval runs out before the maintenance request is approved, sessions go unpaid.
Clinics that buy Spravato up front carry the cost until the payer pays. Without reconciliation between inventory, doses given, and payments received, underpaid and unpaid drug lines go unnoticed.
Payers and auditors look for start time, dose, vital signs, and the time the patient was ready to leave. Missing observation documentation turns a paid claim into a recoupment.
Every Spravato session follows the same clinical steps. What changes is how each payer wants those steps coded.
vitals before dose
56 mg or 84 mg
BP, sedation checks
REMS documentation
One bundled line
G2082 up to 56 mg or G2083 over 56 mg
No separate E/M for the same encounter
Visit code per payer + J0013 × total mg
Example: 84 mg = 84 units of J0013
One Spravato session · 4 steps, 2 billing paths
| Code | What it covers | Used by | What we get right |
|---|---|---|---|
| G2082 | Established-patient visit with supervised self-administration of up to 56 mg, including 2 hours of observation | Medicare and many Medicare Advantage plans | Dose documented in mg; no separate E/M for the same encounter |
| G2083 | Same service with more than 56 mg (typically 84 mg) | Medicare and many Medicare Advantage plans | Dose supports the higher code |
| J0013 | Esketamine nasal spray, 1 mg | Commercial plans and Medicaid plans that cover Spravato as a medical benefit (not payable by Medicare) | Units equal total mg given; authorization updated from S0013 |
| 99212–99215, observation or prolonged service codes | The visit and monitoring time, when the payer doesn't use G-codes | Commercial plans and Medicaid, per payer policy | Payer-specific visit code; monitoring time documented |
| 90833, 90836, 90838 | Psychotherapy add-on, when therapy is separately provided and documented with an E/M | Payers that allow it on a Spravato day | Only when therapy time is distinct from monitoring |
| S0013 | Former esketamine code | Deleted December 31, 2025 | Replaced on every claim and authorization |
| J3490 | Unclassified drug | Only as a bridge when a payer hasn't loaded J0013 | Used only with payer approval and NDC detail |
Diagnosis coding must support the FDA-approved indications, such as treatment-resistant depression coded under F32.x or F33.x, and major depressive disorder with acute suicidal ideation or behavior. JW and JZ wastage modifiers don't apply to J0013.
Payer policies for Spravato vary. We confirm each payer's current visit code and drug code before the first session.
Still seeing S0013 or J3490 on your claims? Get a Free Spravato Billing Audit and we'll check your last 90 days.
Get a Free Spravato Billing Audit →How your clinic gets the drug changes who bills for it, when you're paid, and how much financial risk you carry.
| Buy-and-bill | Specialty pharmacy | |
|---|---|---|
| How it works | Clinic buys Spravato and bills the drug on the medical claim | Pharmacy dispenses the drug to the clinic and bills the patient's plan |
| What the clinic bills | Visit or G-code plus J0013 (or bundled G-code for Medicare) | Visit and observation only |
| Benefit used | Medical benefit | Usually pharmacy benefit |
| Clinic's financial risk | Higher: drug cost carried until paid | Lower: no drug inventory cost |
| Revenue potential | Higher: drug margin plus visit | Lower: visit only |
| What we manage | Benefit checks, J0013 units, inventory-to-claim reconciliation, drug underpayments | Coordination with the pharmacy, visit coding, observation documentation |
Many clinics use both, depending on the patient's plan. We verify which benefit applies before the first dose, so the drug is never billed twice or not at all.
Our Spravato therapy billing services cover every step from the first benefit check to the final drug payment. Choose full revenue cycle management for your Spravato program or the pieces you need.
We confirm whether the plan covers Spravato under the medical or pharmacy benefit, which codes it accepts, prior authorization rules, copays, deductibles, and whether buy-and-bill or specialty pharmacy applies. Eligibility Verification
We build authorization requests with diagnosis, failed antidepressant trials, rating scales, and treatment plan, then track approved sessions and file the next phase before the current one ends. Prior Authorization
We code each session to the payer's model: G2082 or G2083 for Medicare, or the payer's visit code plus J0013 units for commercial and Medicaid plans, with dose and observation documented.
We match every dose given to inventory, claims, and payments, so no purchased drug goes unbilled or underpaid.
Claims are scrubbed for code-payer match, units, NDC requirements, and authorization numbers, then submitted within 48 hours.
We correct and appeal coding, unit, authorization, and medical necessity denials with session documentation and treatment history. Denial Management
We post payments daily and compare drug and visit payments to your contracted rates, including any rate change from S0013 to J0013. Payment Posting
We work every open Spravato claim by value and filing deadline, starting with high-dollar drug lines. AR Follow-Up
We estimate patient costs before treatment and help eligible commercially insured patients apply for manufacturer savings support, so cost doesn't stop treatment. Patient Billing
Starting a Spravato program? We help with payer setup, coding and drug-model decisions, authorization workflow, and billing-ready documentation templates before your first session.
Spravato can only be given in a healthcare setting certified in the Spravato REMS program, with patients monitored for at least two hours after each dose. We don't replace your clinical team's REMS obligations, but we make sure your billing record matches them: dose, administration time, vital signs, observation period, and discharge time on every session note, so claims hold up in payer audits.
Code and unit audit against the 2026 J0013 rules
Authorization review for every active Spravato patient
Buy-and-bill drug reconciliation check
We respond within 1 business day. No obligation.
| Denial cause | How we resolve it |
|---|---|
| Deleted code S0013 or unapproved J3490 | Rebill with J0013 and update the authorization to the new code |
| J0013 units don't match the dose | Correct units to total mg and resubmit |
| Separate E/M billed with G2082 or G2083 | Remove the duplicate visit line, or appeal if a separately identifiable service is documented |
| No authorization or phase approval expired | Request retro-authorization where allowed and file the next phase earlier |
| Medical necessity (not enough failed trials) | Appeal with complete treatment history and rating scales |
| Billed to the wrong benefit (medical vs pharmacy) | Re-route the drug claim and coordinate with the pharmacy |
| Missing observation documentation | Supply session notes with dose, times, and vital signs |
| Program type | What we handle for you |
|---|---|
| Psychiatric practices adding Spravato | Payer setup, drug-model decision, authorization workflow |
| Interventional psychiatry clinics (Spravato and TMS) | Both treatment lines billed and authorized by one team |
| PMHNP-led clinics | Independent billing and credentialing under Nevada's full practice authority |
| Multi-site behavioral health groups | Location-level drug reconciliation and reporting |
| Ketamine clinics adding Spravato | Moving from self-pay infusions to insurance-billed esketamine |
| New Spravato programs | Launch support before the first patient session |
| Payer category | Plans |
|---|---|
| Medicare | Noridian Healthcare Solutions (Jurisdiction E): G2082 and G2083 |
| Medicare Advantage | Health Plan of Nevada/UnitedHealthcare, Humana, Aetna, Anthem, and other MA plans |
| Nevada Medicaid | Fee-for-service Nevada Medicaid; we confirm medical vs pharmacy benefit routing before the first dose |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare/Optum, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Military | TRICARE, following its own Spravato billing rules |
High out-of-pocket costs are a common reason patients stop treatment early. We estimate each patient's cost before induction, and help eligible commercially insured patients enroll in the manufacturer's Spravato withMe savings support. Government-insured patients aren't eligible for manufacturer copay programs, so we set clear expectations up front. Patient Billing
We bill Spravato sessions in AdvancedMD, Valant, Tebra/Kareo, DrChrono, athenahealth, eClinicalWorks, Osmind, SimplePractice, and other systems. No software change needed. EHR Integration
Free Spravato billing audit: We review 90 days of Spravato claims, codes, units, authorizations, and drug payments.
Secure setup: We sign a BAA and connect to your EHR, clearinghouse, and payer portals.
Payer and code mapping: We confirm each payer's visit code, drug code, and benefit route, and update any S0013 authorizations to J0013.
Authorization inventory: Every active Spravato patient's phase, approved sessions, and end date go into tracking.
Go-live: Daily session coding, drug reconciliation, and claim submission begin.
Legacy A/R cleanup: We work old Spravato claims in parallel, starting with unpaid drug lines.
Monthly review: KPI report and a call with your dedicated account manager.
These are the performance standards we manage your Spravato revenue cycle to, based on industry best practices.
| KPI | What it measures | Best-practice target |
|---|---|---|
| First-pass clean claim rate | Spravato claims paid without rework | 95% or higher |
| Denial rate | Claims denied on first submission | Under 5% |
| Days in A/R | Average time from session to payment | Under 35 days |
| Drug reconciliation | Buy-and-bill doses matched to paid claims | Every dose accounted for |
| Authorization gaps | Sessions given without an active approval | Zero, with phase tracking |
| Claim submission | Time from session to claim sent | Within 48 hours |
Claims or authorizations still using S0013 after January 1, 2026
J0013 billed as 1 unit instead of total milligrams
Separate E/M lines billed with Medicare G-codes
Sessions given between the end of induction and approval of maintenance
Purchased doses with no matching paid claim
J0013 paid below your former S0013 rate without a contract update
Spravato billing is usually priced as a percentage of monthly collections, commonly 4–9% for behavioral health. Where your program falls depends on session volume, buy-and-bill vs specialty pharmacy, and how much authorization work your payer mix needs. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| 2026 code changes | Learned from denials | J0013, G2082, and G2083 mapped per payer |
| Authorization phases | Tracked on spreadsheets | Tracked by phase and session |
| Buy-and-bill reconciliation | Often skipped | Every dose matched to a claim |
| Drug underpayments | Rarely noticed | Flagged against contract rates |
| Absences and turnover | Billing stops | Backup team keeps working |
| Cost | Salary, benefits, software | One fee tied to collections |
"Our cash flow will drop." We work old Spravato claims in parallel while new ones go out.
"Patients will miss sessions during the switch." Every active authorization is loaded before go-live.
"We'll lose control." You see every claim in your EHR, plus a monthly review call.
"We're locked in." You're not. The agreement is month-to-month with 30-day notice.
Spravato billing follows the HCPCS Level II and CPT code sets, CMS and payer drug policies, the Spravato REMS program, controlled substance (Schedule III) record-keeping expectations, and HIPAA. We sign a Business Associate Agreement before accessing any patient data.
Current coding: J0013, G2082, and G2083 applied by payer since the 2026 change.
Drug revenue protected: Buy-and-bill doses reconciled to paid claims.
No authorization gaps: Every phase filed before the last one ends.
Psychiatry depth: The same team bills your medication visits and TMS.
Nevada payer expertise: Noridian, five Medicaid MCOs, and local commercial plans.
No lock-in: Month-to-month agreement with 30-day notice.
Las Vegas: Interventional psychiatry clinics, multi-site behavioral health groups, and practices offering both Spravato and TMS. Las Vegas billing
Henderson: Private psychiatric practices adding Spravato for commercially insured patients. Henderson billing
North Las Vegas: Clinics serving many Medicare Advantage and Medicaid MCO patients. North Las Vegas billing
Reno: Psychiatric practices serving Washoe County and patients traveling from rural northern Nevada. Reno billing
Carson City: Outpatient psychiatry clinics bringing Spravato to the capital region. Carson City billing
We also support Spravato programs in Sparks, Summerlin, Pahrump, and Elko.
We help Nevada clinics bill Spravato correctly under the 2026 codes, keep authorizations active through every phase, and recover drug revenue.
Free 90-day review · No obligation · HIPAA compliant
Behavioral health billing servicesPsychiatry billing servicesABA billing servicesPrimary care billing servicesSpravato billing services manage the revenue cycle for esketamine treatment: benefits investigation, prior authorization, session coding, drug billing, claim submission, payment posting, denial appeals, and A/R follow-up.
For commercial and Medicaid plans that cover it as a medical benefit, the drug is billed with J0013 (esketamine, nasal spray, 1 mg), one unit per milligram. Medicare uses G2082 (up to 56 mg) or G2083 (over 56 mg), which bundle the visit and two-hour observation.
J0013 replaced S0013 on January 1, 2026. Claims and prior authorizations that still reference S0013 need to be updated.
Generally no. G2082 and G2083 already include the visit and observation, so a separate E/M for the same encounter is usually denied. A separately identifiable service on the same day must be clearly documented.
84 units. J0013 is reported per milligram, so units equal the total dose given.
Buy-and-bill offers more revenue but requires carrying drug costs until payment. Specialty pharmacy lowers risk but limits revenue to the visit. Many clinics use both, depending on each patient's plan.
It varies by payer, from a few days to several weeks. Most plans require a confirmed diagnosis, failed antidepressant trials, and rating scale scores, and many approve induction and maintenance separately.
Medicare covers Spravato for its FDA-approved indications when billed with G2082 or G2083 at a REMS-certified site.
Yes. We help with payer setup, the drug-model decision, authorization workflow, and billing-ready documentation templates before your first patient.
Most behavioral health billing is priced at 4–9% of collections. We give a fixed quote after a free audit.