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May 1, 2023 - Revised: 12.21.23

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.comExternal Website or 1-855-382-6022.

To bill claims for Spravato:

  • Select the appropriate HCPCS code:
    • 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
    Don’t add miscellaneous drug code (J-codes) as the above codes include the drug.
  • Append modifier KX to identify enrollment in the FDA REMS program.
    • Modifier KX acknowledges the provider that performed the service and submitted the claim is an FDA REMS approved facility.
    • A claim submitted with HCPCS code G0282 or G0283 and no modifier KX will deny.
    • A claim submitted by a healthcare system that is not enrolled in the REMS program is subject to denial.
  • Enter the facility name and ZIP code:
    • For Part A claims, use:
      • Line SV202-7 (837I electronic claim)
      • Block 80 (hard copy UB-04 claim form)
    • For Part B claims, use:
      • Loop 2400 or SV101-8 (837P electronic claim)
      • Box 19 (hard copy CMS-1500 claim form)
  • Select the appropriate ICD-10 code:
    • F32.2
    • F32.3
    • F33.2
    • F33.3
    • F33.41
    • F33.42

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